Global Gender Differences in Pilonidal Sinus Disease: A Random-Effects Meta-Analysis
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ORIGINAL SCIENTIFIC REPORT
Global Gender Differences in Pilonidal Sinus Disease: A Random-Effects Meta-Analysis Markus M. Luedi1 • Patrick Schober2 • Verena K. Stauffer3 • Maja Diekmann4 Dietrich Doll4
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Accepted: 8 July 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Pilonidal sinus disease (PSD) is traditionally associated with young male patients. While PSD is rare in Asia and Africa, lifestyles are changing considerably throughout the so-called developed world. We question that PSD is an overwhelmingly male disease and that the proportion of women suffering from PSD is worldwide evenly distributed in a homogenous matter. Methods We analysed the world literature published between 1833 and 2018, expanding on the database created by Stauffer et al. Following correction for gender bias with elimination of men-only and women-only studies, data were processed using random-effects meta-analysis in the technique of DerSimonian and Laird. Results The share of female pilonidal sinus disease patients analysed from all studies available in the world literature is 21%. There are marked regional differences including South America (39%), North America as well as Australia/ New Zealand (29%) and Asia (7%), which are highly significant. These results stand fast even if analysis without gender bias corrections was applied. Conclusion The share of female patients suffering from PSD is considerable. It is time to think of PSD as a disease of both men and women. Previously unknown, there are significant regional differences worldwide; the reason(s) for the regional differences is still unclear.
Introduction
& Dietrich Doll [email protected] 1
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
2
Department of Anesthesiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
3
Department of Emergency Medicine, Lindenhof Group Bern, Bern, Switzerland
4
Department of Procto-Surgery, St. Marienhospital Vechta, Academic Teaching Hospital of the MHH Hannover, Vechta, Germany
‘‘Human clinical research suffers from a lack of sex-based reporting and sex-based analysis of the results’’ is a straightforward Joint Statement made by the Surgery Journal Editors Group. It was not published decades ago, but recently in 2018 [1]. Mansukhani analysed 2347 articles, identified 1668 studies with human participants and concluded that 4.4% of all studies were single-gender studies, with 1.3% with only men and 3.1% with only women. Less than one-third of the studies analysed their data in relation to gender, and less than one-fourth discussed their results in a gender-related manner [2]. Thus, as Lundine urges in her Lancet commentary 2019, genderrelated research should be encouraged [3]. Gender bias will by no means easily overcome [4], as it is common and even
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deep rooted even in medical education [5, 6] and influence medical decisions [7]. Not surprisingly, the perception of g
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