Sex-Based Differences in Surgical Stabilization Outcomes for Rib Fractures in Blunt Trauma Patients
Negaar Aryan1, Sebastian Dominik Schubl1, Jeffry Nahmias1
1University of California Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, CA, USA.
Abstract:
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.
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