Females have fewer complications and lower mortality following trauma than similarly injured males: A risk adjusted analysis of adults in the National Trauma Data Bank

• Published in: Surgery Vol. 146; no. 2; pp. 308 - 315
• Main Authors: Haider, Adil H., MD, MPH, Crompton, Joseph G., MD, Oyetunji, Tolulope, MD, MPH, Stevens, Kent A., MD, MPH, Efron, David T., MD, Kieninger, Alicia N., MD, Chang, David C., MPH, MBA, PhD, Cornwell, Edward E., MD, Haut, Elliott R., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-08-2009; Elsevier
• Subjects: Abdominal Abscess - etiology; Abdominal Abscess - mortality; Acute Kidney Injury - etiology; Acute Kidney Injury - mortality; Adult; Biological and medical sciences; Databases, Factual; Epidemiology; Female; General aspects; Hospital Mortality; Hospitalization; Humans; Male; Medical sciences; Pneumonia - etiology; Pneumonia - mortality; Public health. Hygiene; Public health. Hygiene-occupational medicine; Pulmonary Embolism - drug therapy; Pulmonary Embolism - mortality; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - mortality; Risk Factors; Sex Distribution; Surgery; Survival Rate; United States; Wounds and Injuries - complications; Wounds and Injuries - mortality; Wounds and Injuries - pathology; United States; Human; Medicine; Treatment; Surgery; Mortality; Adult; Complication; Female; Male; Risk analysis; Epidemiology; Trauma
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2009.05.006

Background Studies of sexual dimorphism in trauma outcomes suggest that women have a survival advantage compared to equivalently injured men. It is unknown if this gender disparity is mediated by potentially life-threatening complications. Objective To determine (1) if there is a sex-based differences in the odds of developing inpatient complications after trauma, and (2) if are these complications associated with death among trauma patients. Methods Review of adult trauma patients admitted to hospitals in the National Trauma Data Bank that report complications. Patient and injury severity covariates were adjusted using multiple logistic regression and the independent effect of sex on developing complications and associated mortality was determined. Results A total of 681,730 adult patients met the inclusion criteria of hospital admission ≥3 days. Women demonstrated a 21% lower adjusted risk of death compared to males (OR 0.79, 95% CI 0.76–0.83). Females had decreased adjusted odds of developing life-threatening complications including pneumonia, acute respiratory distress syndrome, acute renal failure and pulmonary embolism. However, when compared to males with life-threatening complications, females with complications were found to be at greater risk of dying. Conclusion This study demonstrates that women are less likely than men to develop inpatient complications, suggesting that the survival advantage among women after traumatic injury may involve a reduced susceptibility to developing life-threatening complications.