Sex and gender in perioperative cardiovascular research: a protocol for a scoping review

Abstract Background Inadequate inclusion of sex and gender in medical research has resulted in biased clinical guidance and disparities in knowledge and outcomes. Despite decades of efforts by regulatory and funding agencies, opportunities to generate sex specific knowledge are routinely neglected. Certain disciplines in cardiovascular medicine have made great strides, however, these advances have yet to permeate the literature on perioperative cardiovascular complications in non-cardiac surgery. Prompted by the recent findings on sex-specific perioperative cardiovascular outcomes, this review aims to scope the literature in this field and categorize methodological approaches used to incorporate sex and gender as variables in this patient population. Methods Joanna Briggs Institute (JBI) methodology for scoping reviews will be followed in stages elaborated by Levac (2010). Detailed search strategy will be used to identify relevant primary research published since 2010. Screening against inclusion and exclusion criteria will be performed by independent reviewers. Data will be extracted from full text and additional materials of articles in the final selection. Results will be presented as proportions of studies reporting sex and gender, the assigned purpose of these variables in analysis and where they were reported in the article. In addition, articles will be mapped to the source, country of origin, and year of publication. Narrative summaries will be used to outline major findings and the depth of literature within each of the major topics (risk assessment/prediction, diagnosis, treatment, prognosis, and outcomes). Discussion Rising awareness of profound and complex implications of sex and gender in medicine has prompted calls for greater attention to participation equity, sex specific analysis and reporting. Focusing on perioperative cardiovascular complications, this study has the potential to identify knowledge gaps for further research, as well as areas of strength that could support formal knowledge synthesis or secondary analysis of data from past research. Scoping Review Registration Submitted on August 15th, 2023 (Web of Science osf.io/u25sf, pending approval)