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In this cohort study of more than 1 million patients, women had a higher operative mortality and incidence of the composite of operative mortality and morbidity compared with men. The attributable risk of female sex for operative mortality varied from 1.28 in 2011 to 1.41 in 2020, with no significant change over the study period and the attributable risk for the composite of operative mortality and morbidity was 1.08 in both 2011 and 2020 with no significant change over the study period.