Female surgical patients with preoperative iron deficiency anemia had lower 30-day postoperative mortality (1.79% vs. 2.35%, RR: 0.76) and reduced major morbidities compared to male patients.
Does female sex compared to male sex affect 30-day postoperative outcomes in adult surgical patients with preoperative iron deficiency anemia?
Female surgical patients with preoperative iron deficiency anemia have significantly lower 30-day postoperative mortality and morbidity compared to males, though these sex differences are less pronounced in cardiac surgery.
Absolute Event Rate: 0% vs 0%
Abstract Background Preoperative iron deficiency anemia (IDA) affects 30%–44% of non‐cardiac surgical patients and is associated with poor postoperative outcomes. Few studies have examined IDA surgical patients' outcomes by sex. Study Design and Methods TriNetX Research Network was queried from 2005 to 2025. We compared adult female and male surgical patients with IDA within 1 month preoperatively. Sub‐analyses were performed for ages 18–55, 56+ years, and cardiac surgical patients. We performed propensity score matching on surgical type, demographics, and comorbidities. We tracked 30‐day postoperative mortality, respiratory, renal, ischemic, thrombotic, infectious, and combined morbidity, RBC transfusions, and hemorrhage. Results After matching, 418,172 IDA patients were in each cohort. Female patients had lower risk of 30‐day postoperative mortality than male patients (1.79% vs. 2.35%, Risk Ratio (RR): 0.76 95% Confidence Interval: 0.74–0.79), respiratory morbidity (1.25% vs. 2.16%, RR: 0.58 0.56–0.60), renal morbidity (6.00% vs. 8.67%, RR: 0.69 0.68–0.70), ischemic morbidity (3.04% vs. 3.89%, RR: 0.78 0.76–0.80), thromboembolic morbidity (2.86% vs. 3.39%, RR: 0.84 0.82–0.86), infectious morbidity (5.17% vs. 7.96%, RR: 0.65 0.64–0.66), and hemorrhage (0.18% vs. 0.24%, RR: 0.77 0.70–0.85). Sex had a lesser impact after cardiac surgery. Female sex was associated with a lower risk of infectious morbidity, combined morbidity, and renal morbidity; all other outcomes were not significant. Discussion Our findings underscore the importance of incorporating sex‐specific considerations into perioperative risk stratification, particularly in patients with preoperative anemia. Most sex differences were not present in cardiac surgery patients, suggesting potential interactions between surgical type, baseline risk, and transfusion or anticoagulation practices.
Choi et al. (Thu,) reported a other. Female surgical patients with preoperative iron deficiency anemia had lower 30-day postoperative mortality (1.79% vs. 2.35%, RR: 0.76) and reduced major morbidities compared to male patients.