Gender Differences in Gastrointestinal, Hepatobiliary and Pancreatic Surgery and Perceived Relevance on Outcomes <br/>—A Single Center 22-Year Observational Study in India (1996-2018)

Introduction: Gender differences are still quite prevalent in the present time. Although there is literature regarding gender differences in healthcare expenditure in India, there is no data regarding gender differences in hospital stay, hospital seeking behaviors and mortality. Aim: To evaluate the Gender differences in a hospital seeking behavior, mortality and hospital stay. Methods: We prospectively analyzed, from a retrospective database, all patients who underwent surgical gastrointestinal, hepato-biliary, pancreatic and splenic surgeries from 1996 to 2018 in our unit. Patients were divided into groups based on gender, admission time period and priority of admission i.e., elective or emergency. Both the gender groups were compared with respect to total procedures done, hospital stay and mortality. Organ specific mortality was calculated as proportions, was analyzed and compared between the groups. Time trends of the same were observed and compared. Results: Of 12,411 patients, 7979 (64.3%) were males and 4432 (35.7%) were females. 9191 (74.1%) patients underwent elective procedures whereas 3220 (25.9%) had emergency procedures (p ≤ 0.001). Overall mortality was higher in males (n = 473, 5.92%) in comparison to females (n = 185, 4.17%) (p ≤ 0.001). Majority of surgeries in males were of small intestine (22.5%) in which small bowel resection was most commonly done (5.4%), whereas, gallbladder and biliary surgeries (27.4%) were the most common in females in which laparoscopic cholecystectomy was most commonly done (5.8%). Median hospital stay was higher in males (10 days vs 9 days), (p ≤ 0.001). Mortality was higher in females in all organ categories except in liver (6.34% vs 2.7%), pancreas (37.3% Vs 18.3%) and spleen (3.38% Vs 1.62%) where mortality was higher for male gender. Highest mortality for females was in small intestinal surgery (34%) and for males, it was pancreatic surgery (37.3%). Highest mortality in males was emergency open pancreatic necrosectomy (21.6%) and that in females was emergency small intestinal surgery (11.9%). Although the number of surgeries in females increased over time (380 in 1996-1999 Vs 951 in 2016-2018), the proportion remained constant (36.3% Vs 38.3% in 1996-1999 and 2016-2018 respectively). Conclusion: We conclude that mortality is found to be higher in males after gastrointestinal surgery, which may be explained by the fact that hospital seeking behavior is more in males though it is fairly increasing in females in the recent years.

在有经历非肝的外科的肝疾病的病人的 Perioperative 风险因素

The patients with liver disease present for various surgical interventions. Surgery may lead to complications in a significant proportion of these patients. These complications may result in considerable morbidity and mortality. Preoperative assessment can predict survival to some extent in patients with liver disease undergoing surgical procedures. A review of literature suggests nature and the type of surgery in these patients determines the peri-operative morbidity and mortality. Optimization of premorbid factors may help to reduce perioperative mortality and morbidity. The purpose of this review is to discuss the effect of liver disease on perioperative outcome; to understand various risk scoring systems and their prognostic significance; to delineate different preoperative variables implicated in postoperative complications and morbidity; to establish the effect of nature and type of surgery on postoperative outcome in patients with liver disease and to discuss optimal anaesthesia strategy in patients with liver disease.

Successful Resection in a Case of Hepatocellular Carcinoma Masquerading as Hilar Cholangiocarcinoma: A Case Report

Obstructive jaundice in the setting of a hilar mass raises strong suspicion of a cholangiocarcinoma,with diagnosis usually made on imaging.Jaundice,when present in patients with hepatocellular carcinoma,is mostly related to underlying liver disease(i.e.cirrhosis)and only rarely to diffuse tumor infiltration of liver parenchyma or hilar invasion.We report here the good outcome of a 67 year-old patient who presented with obstructive jaundice,underwent surgery and was given a diagnosis of hepatocellular carcinoma,which was made only at histopathological examination of resected specimen.