Mitchell Monique, Taghlabi Khaled M, Moiz Bilal, Ganni Samad, Balasubramanian Kishore, Sankarappan Kiran, Costa Marcelo, Ganni Sidra, Buccilli Barbara, Paiva Wellingson, Bertani Raphael, Faraji Amir H
Department of Neurosurgery, Houston Methodist Hospital, Houston, TX, USA.
University of Maryland School of Medicine, Baltimore, MD, USA.
Neurocrit Care. 2025 Sep 16. doi: 10.1007/s12028-025-02377-z.
Traumatic brain injury (TBI) is a Major contributor to morbidity and mortality in the United States. Although prior research has suggested potential gender differences in TBI outcomes, limited data exist on surgical cohorts. This study aimed to evaluate gender-based disparities in postoperative complications and 30-day outcomes following surgical management of TBI using a large national surgical registry.
A retrospective cohort study was performed using the 2023 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Adults (≥ 18 years) who underwent surgical intervention for TBI were identified using Current Procedural Terminology codes. Patients were stratified by gender, and comparisons were made using Wilcoxon rank-sum and χ tests. Multivariate logistic regression was conducted to assess independent predictors of 30-day morbidity and mortality.
Of the 2,519 patients, 64.8% were Male and 35.2% were female. Female patients were significantly older (70.9 ± 14.6 vs. 67.2 ± 16.0 years, p < 0.001) and had higher rates of hypertension (65.1% vs. 58.1%, p < 0.001), bleeding disorders (25.5% vs. 19.4%, p < 0.001), and frailty (modified frailty index ≥ 2 in 31.0% vs. 28.6%, p < 0.001). Additionally, postoperative urinary tract infections (odds ratio [OR] 2.35, 95% confidence interval [CI] 1.56-3.55, p < 0.001), transfusion requirement (OR 1.67, 95% CI 1.34-2.08, p < 0.001), and 30-day morbidity (OR 1.29, 95% CI 1.10-1.52, p = 0.002) were significantly higher in female patients. Multivariate analysis confirmed female gender as an independent predictor of 30-day morbidity (OR 1.31, 95% CI 1.02-1.68, p = 0.034). No significant difference in 30-day mortality between male and female patients was observed (OR 1.08, 95% CI 0.87-1.33, p = 0.493).
Female patients undergoing surgical treatment for TBI experience significantly higher postoperative morbidity despite comparable mortality. Increased age, comorbidity burden, and complication rates in female patients underscore the need for gender-specific perioperative strategies. Limitations include the 30-day follow-up window and retrospective design. These findings support further investigation into tailored interventions to mitigate gender disparities in neurosurgical care.
创伤性脑损伤（TBI）是美国发病和死亡的主要原因。尽管先前的研究表明TBI的预后可能存在性别差异，但关于手术队列的数据有限。本研究旨在利用一个大型国家手术登记系统评估TBI手术治疗后术后并发症和30天预后的性别差异。
使用2023年美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库进行回顾性队列研究。通过当前手术操作术语代码识别接受TBI手术干预的成年人（≥18岁）。患者按性别分层，并使用Wilcoxon秩和检验和χ检验进行比较。进行多因素逻辑回归以评估30天发病率和死亡率的独立预测因素。
在2519例患者中，64.8%为男性，35.2%为女性。女性患者年龄显著更大（70.9±14.6岁对67.2±16.0岁，p<0.001），高血压（65.1%对58.1%，p<0.001）、出血性疾病（25.5%对19.4%，p<0.001）和虚弱（改良虚弱指数≥2在31.0%对28.6%，p<0.001）发生率更高。此外，女性患者术后尿路感染（比值比[OR]2.35，95%置信区间[CI]1.56-3.55，p<0.001）、输血需求（OR 1.67，95%CI 1.34-2.08，p<0.001）和30天发病率（OR 1.29，95%CI 1.10-1.52，p=0.002）显著更高。多因素分析证实女性性别是30天发病率的独立预测因素（OR 1.31，95%CI 1.02-1.68，p=0.034）。未观察到男性和女性患者30天死亡率的显著差异（OR 1.08，95%CI 0.87-1.33，p=0.493）。
接受TBI手术治疗的女性患者尽管死亡率相当，但术后发病率显著更高。女性患者年龄增加、合并症负担和并发症发生率强调了针对性别制定围手术期策略的必要性。局限性包括30天的随访窗口和回顾性设计。这些发现支持进一步研究定制干预措施以减轻神经外科护理中的性别差异。
