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Innate Biological Vulnerability: Male Sex as an Independent Risk Factor for Postoperative Pulmonary Complications in

Change Zhu1, Xiaobing Li2, Rufang Zhang2

  • 1Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Journal of Cardiothoracic and Vascular Anesthesia
|May 22, 2026
PubMed

Insights

Male infants undergoing thoracic surgery face a significantly higher risk of postoperative pulmonary complications (PPCs). This study found male sex independently increases PPC risk by 2.5-fold, suggesting innate biological vulnerability.

Area of Science:

  • Pediatric Thoracic Surgery
  • Pulmonary Complications
  • Sex-Based Risk Factors

Background:

  • Postoperative pulmonary complications (PPCs) are a significant concern in infant thoracic surgery.
  • The role of sex as an independent risk factor for PPCs in this population remains unclear.

Purpose of the Study:

  • To investigate whether male sex independently predicts an increased risk of postoperative pulmonary complications (PPCs).
  • To evaluate the association between male sex and PPCs in infants undergoing video-assisted thoracic surgery with one-lung ventilation.

Main Methods:

  • Retrospective cohort study of 547 infants undergoing elective video-assisted thoracic surgery lung resection.
  • Standardized intraoperative management including one-lung ventilation and postoperative fast-track extubation.
  • Multivariable logistic regression and propensity-score matching were used to analyze the association between male sex and PPCs, adjusting for confounding variables.

Main Results:

  • Overall PPC incidence was 17.4%, with a higher crude rate in boys (24%) compared to girls (11%).
  • Male sex was an independent predictor of PPCs across six multivariable models, with an adjusted odds ratio ranging from 2.28 to 2.49.
  • The association remained significant after propensity-score matching (adjusted OR, 2.34).

Conclusions:

  • Male sex is associated with a 2.5-fold increased risk of PPCs in infants undergoing thoracic surgery.
  • This finding suggests an innate male biological vulnerability.
  • Sex-specific perioperative surveillance strategies may be beneficial for infant thoracic surgery patients.
Abstract

Keywords:
infantone-lung ventilationpostoperative pulmonary complicationssex characteristics

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