{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:22:02Z","timestamp":1764289322067,"version":"3.46.0"},"reference-count":36,"publisher":"The Korean Society of Anesthesiologists","issue":"6","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT","doi-asserted-by":"crossref","award":["RS-2022-00165755"],"award-info":[{"award-number":["RS-2022-00165755"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["HR21C0198"],"award-info":[{"award-number":["HR21C0198"]}],"id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005006","name":"Asan Institute for Life Sciences, Asan Medical Center","doi-asserted-by":"publisher","award":["2024IP0091"],"award-info":[{"award-number":["2024IP0091"]}],"id":[{"id":"10.13039\/501100005006","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["ekja.org"],"crossmark-restriction":true},"short-container-title":["Korean J Anesthesiol"],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:p>Background: The sex-specific association between serum uric acid (SUA) levels and postoperative outcomes in elective non-cardiac surgery remains unclear. This study aimed to identify sex-specific SUA thresholds and their impact on short- and long-term outcomes.Methods: A retrospective analysis of 295\u2009267 patients (2012\u20132021) undergoing non-cardiac surgery was conducted. Patients were stratified by preoperative SUA levels: for males (&lt; 4 to \u2265 9 mg\/dl) and females (&lt; 3 to \u2265 8 mg\/dl), with mid-range levels as reference. Mortality (30-day to overall) and complications were assessed using Cox and logistic regression. Cubic splines evaluated nonlinear trends, with subgroup analyses by age and surgical risk.Results: SUA levels exhibited a nonlinear, sex-specific association with postoperative outcomes. The estimated lower-risk SUA range was 5.08\u20137.63 mg\/dl in males and 3.34\u20135.35 mg\/dl in females. In Cox and spline analyses, a U-shaped association between SUA and mortality was observed in both sexes, with significant risks at both low (&lt; 4 mg\/dl) and high (\u2265 9 mg\/dl) levels in males, and predominantly at low levels (&lt; 3 mg\/dl) in females. The types of complications varied subtly between sexes. Within SUA ranges of 4\u20136 mg\/dl (males) and 3\u20134 mg\/dl (females), composite and specific complication risks were lower than at either extreme, showing a protective effect, with reduced risk of acute kidney injury in males and pneumonia in females. Additionally, extreme SUA levels were significantly associated with increased mortality and complications, particularly in low-risk surgical patients.Conclusions: Preoperative SUA levels show a nonlinear, sex-specific association with postoperative outcomes, highlighting the need for sex- and risk-based perioperative stratification.<\/jats:p>","DOI":"10.4097\/kja.25517","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T06:05:56Z","timestamp":1755842756000},"page":"569-582","update-policy":"https:\/\/doi.org\/10.4097\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex-specific associations of preoperative serum uric acid levels with mortality and morbidity in non-cardiac surgeries: a single-center retrospective 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