The American surgeon · 2025
Sex-Based Differences in Surgical Stabilization Outcomes for Rib Fractures in Blunt Trauma Patients.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Aryan Negaar, Schubl Sebastian Dominik, Nahmias Jeffry, Dolich Matthew, Lekawa Michael, Nie Jiabao, Grigorian Areg
Аннотация
UNLABELLED: Sex-based differences in rib fracture presentation and recovery may influence surgical stabilization of rib fractures (SSRF) outcomes. Greater chest wall muscle mass in males may necessitate higher-energy trauma to cause rib fractures, increasing the risk of respiratory complications.
OBJECTIVE: We compared the rates of SSRF in male and female blunt trauma patients (BTPs) with rib fractures, hypothesizing that males would undergo SSRF at a higher rate and experience increased respiratory complications following SSRF.
METHODS: TQIP (2017-2022) was queried for adult BTPs with multiple rib fractures and/or flail segment. Male SSRF BTPs were compared to female SSRF BTPs. Multivariable logistic regression analysis was performed to determine if sex was associated with an increased risk of respiratory complications [unplanned intubation, acute respiratory distress syndrome (ARDS), and ventilator-associated pneumonia (VAP)].
RESULTS: The rate of SSRF in males was 3.1% and 2.3% in females (P < .001). From 20 487 SSRF patients, 15 086 (74%) were male. Both groups had similar median injury severity scores (ISS) of 17; however, males had higher rates of severe thoracic injury (34.7% vs 31.1%, P < .001). Males had higher rates of overall respiratory complications (13.0% vs 10.3%) including ARDS (1.9% vs 1.3%), VAP (3.9% vs 2.4%), and unplanned intubation (7.8% vs 6.8%) (all P < .05). On multivariable analysis, males had an increased risk of respiratory complications (OR 1.37, CI 1.24-1.52, P < .001) and mortality (OR 1.33, CI 1.07-1.65, P = .01).
CONCLUSION: Despite comparable ISS, males more frequently underwent SSRF and had increased risk of respiratory complications and mortality post-operatively. These disparities may reflect underlying anatomical/physiological factors.
OBJECTIVE: We compared the rates of SSRF in male and female blunt trauma patients (BTPs) with rib fractures, hypothesizing that males would undergo SSRF at a higher rate and experience increased respiratory complications following SSRF.
METHODS: TQIP (2017-2022) was queried for adult BTPs with multiple rib fractures and/or flail segment. Male SSRF BTPs were compared to female SSRF BTPs. Multivariable logistic regression analysis was performed to determine if sex was associated with an increased risk of respiratory complications [unplanned intubation, acute respiratory distress syndrome (ARDS), and ventilator-associated pneumonia (VAP)].
RESULTS: The rate of SSRF in males was 3.1% and 2.3% in females (P < .001). From 20 487 SSRF patients, 15 086 (74%) were male. Both groups had similar median injury severity scores (ISS) of 17; however, males had higher rates of severe thoracic injury (34.7% vs 31.1%, P < .001). Males had higher rates of overall respiratory complications (13.0% vs 10.3%) including ARDS (1.9% vs 1.3%), VAP (3.9% vs 2.4%), and unplanned intubation (7.8% vs 6.8%) (all P < .05). On multivariable analysis, males had an increased risk of respiratory complications (OR 1.37, CI 1.24-1.52, P < .001) and mortality (OR 1.33, CI 1.07-1.65, P = .01).
CONCLUSION: Despite comparable ISS, males more frequently underwent SSRF and had increased risk of respiratory complications and mortality post-operatively. These disparities may reflect underlying anatomical/physiological factors.