Trista D Reid1,2,3, Sherry M Wren4, Joanna Grudziak5,6, Rebecca Maine5,6,7, Chifundo Kajombo6, Anthony G Charles5,6,7. 1. Department of Surgery, University of North Carolina- Chapel Hill, 4001 Burnett-Womack Building CB# 7050, Chapel Hill, NC, 27599-7050, USA. trista_reid@med.unc.edu. 2. Department of Surgery, Kamuzu Central Hospital, P.O. Box 149, Lilongwe, Malawi. trista_reid@med.unc.edu. 3. UNC School of Medicine, University of North Carolina, 4008 Burnett Womack Building, Chapel Hill, NC, 27599, USA. trista_reid@med.unc.edu. 4. Department of Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94304, USA. 5. Department of Surgery, University of North Carolina- Chapel Hill, 4001 Burnett-Womack Building CB# 7050, Chapel Hill, NC, 27599-7050, USA. 6. Department of Surgery, Kamuzu Central Hospital, P.O. Box 149, Lilongwe, Malawi. 7. UNC School of Medicine, University of North Carolina, 4008 Burnett Womack Building, Chapel Hill, NC, 27599, USA.
Abstract
INTRODUCTION: There is a paucity of data regarding sex-based disparities in surgical care delivery, particularly in low- and middle-income countries. This study sought to determine whether sex disparities are present among patients presenting with surgical conditions in Malawi. Hypothesis compared to men, fewer women present to Kamuzu Central Hospital (KCH) with peritonitis and have longer delays in presentation for definitive care. METHODS: This study performs a retrospective analysis of prospectively collected data of all general surgery patients with peritonitis presenting to KCH in Lilongwe, Malawi, from September 2013 to April 2016. Multivariable linear and logistic regressions were used to assess the effect of sex on mortality, length of stay, operative intervention, complications, and time to presentation. RESULTS: Of 462 patients presenting with general surgery conditions and peritonitis, 68.8% were men and 31.2% were women. After adjustments, women had significantly higher odds of non-operative management when compared to men (OR 2.17, 95%CI 1.30-3.62, P = 0.003), delays in presentation (adjusted mean difference 136 h, 95%CI 100-641, P = 0.05), delays to operation (adjusted mean difference 1.91 days, 95%CI 1.12-3.27, P = 0.02), and longer lengths of stay (adjusted mean difference 1.67 days, 95%CI 1.00-2.80, P = 0.05). There were no differences in complications or in-hospital or Emergency Department mortality. CONCLUSION: Sex disparities exist within the general surgery population at KCH in Lilongwe, Malawi. Fewer women present with surgical problems, and women experience delays in presentation, longer lengths of stay, and undergo fewer operations. Future studies to determine mortality in the community and driving factors of sex disparities will provide more insight.
INTRODUCTION: There is a paucity of data regarding sex-based disparities in surgical care delivery, particularly in low- and middle-income countries. This study sought to determine whether sex disparities are present among patients presenting with surgical conditions in Malawi. Hypothesis compared to men, fewer women present to Kamuzu Central Hospital (KCH) with peritonitis and have longer delays in presentation for definitive care. METHODS: This study performs a retrospective analysis of prospectively collected data of all general surgery patients with peritonitis presenting to KCH in Lilongwe, Malawi, from September 2013 to April 2016. Multivariable linear and logistic regressions were used to assess the effect of sex on mortality, length of stay, operative intervention, complications, and time to presentation. RESULTS: Of 462 patients presenting with general surgery conditions and peritonitis, 68.8% were men and 31.2% were women. After adjustments, women had significantly higher odds of non-operative management when compared to men (OR 2.17, 95%CI 1.30-3.62, P = 0.003), delays in presentation (adjusted mean difference 136 h, 95%CI 100-641, P = 0.05), delays to operation (adjusted mean difference 1.91 days, 95%CI 1.12-3.27, P = 0.02), and longer lengths of stay (adjusted mean difference 1.67 days, 95%CI 1.00-2.80, P = 0.05). There were no differences in complications or in-hospital or Emergency Department mortality. CONCLUSION: Sex disparities exist within the general surgery population at KCH in Lilongwe, Malawi. Fewer women present with surgical problems, and women experience delays in presentation, longer lengths of stay, and undergo fewer operations. Future studies to determine mortality in the community and driving factors of sex disparities will provide more insight.
Authors: Laura N Purcell; Rachel Reiss; Charles Mabedi; Jared Gallaher; Rebecca Maine; Anthony Charles Journal: World J Surg Date: 2020-07 Impact factor: 3.352
Authors: Kajal Mehta; Hana Arega; Natalie L Smith; Kathleen Li; Emma Gause; Joohee Lee; Barclay Stewart Journal: Am J Surg Date: 2021-07-24 Impact factor: 2.565