Association of patient sex with operative time and intraoperative systolic blood pressure excursions during sleeve gastrectomy

Biological differences between women and men, including differences in body fat distribution and obesity-related comorbidities, may influence the technical and perioperative course of metabolic and bariatric surgery. However, evidence regarding sex-related differences during sleeve gastrectomy remains limited. The aim of this study was to evaluate the association between patient sex and operative time in patients undergoing SG. The secondary aim was to evaluate the association between patient sex and intraoperative systolic blood pressure excursions. This retrospective single-center study included patients who underwent primary sleeve gastrectomy between 2024 and 2025. Baseline and perioperative variables included age, preoperative body mass index, hypertension, type 2 diabetes, mean arterial pressure at hospital admission, operative time and individual surgeon. Baseline systolic blood pressure was defined as the first measurement obtained in the operating room before induction. The secondary outcome was defined as the occurrence of any intraoperative systolic blood pressure increase or decrease exceeding 20% relative to the pre-induction baseline. A total of 463 patients were included, comprising 338 women (73.0%) and 125 men (27.0%). Male patients were older than female patients (45.0 vs. 40.0 years, p < 0.001), had a higher preoperative body mass index (42.4 vs. 40.6 kg/m², p = 0.011), and more frequently had hypertension (66.4% vs. 36.1%, p < 0.001). Operative time was significantly longer in male patients (35.0 vs. 30.0 min, p < 0.001). The proportion of patients without a predefined SBP excursion did not differ significantly between women and men (29.6% vs. 34.4%, p = 0.320). The adjusted sex-associated difference in operative time was 2.64 min. Because heteroscedasticity was detected, HC3 robust standard errors were applied, and the association was not statistically significant (95% CI − 0.41 to 5.70; p = 0.090). Increasing age and individual surgeon remained significantly associated with operative time. Male patients had longer operative times, although the adjusted sex-associated difference was small and not statistically significant in the robust sensitivity analysis. Increasing age and individual surgeon remained associated with operative duration. Male sex was not significantly associated with the predefined SBP excursion outcome.