Sex disparities in postoperative outcomes after neurosurgical intervention: findings from the UMEND project.
BACKGROUND
Little is known about the relationship between sex and the risk of complications after neurosurgical intervention. Improved understanding of this relationship may assist clinicians in advising patients of the risks and benefits of neurosurgical intervention and managing their patients after surgery.


OBJECTIVE
To determine the independent relationship between sex and morbidity after neurosurgical intervention.


METHODS
Data were collected for 918 neurosurgical cases at the University of Michigan Hospitals. Bivariate χ(2) tests and analysis of variance were used to assess relationships between sex, demographics, case type, medical comorbidities, postoperative complication risk, and postoperative hospital and intensive care unit stay. We fit a multivariable logistic regression model of 30-day complication risk by sex adjusted for potential confounders and used multifactor analysis of variance to assess the relationship between sex and hospital as well as intensive care unit stay, adjusted for potential confounders.


RESULTS
The percentages of patients experiencing complications within 30 days of surgery were 20.3% for male and 11.3% for female patients. In multivariable regression models, male sex predicted postoperative complications compared with female sex (odds ratio: 2.0, 95% confidence interval: 1.4-3.0). By multifactor analysis of variance, male sex was associated with longer hospital stay (P < .01), but was not associated with neurosurgical intensive care unit stay.


CONCLUSIONS
Our findings suggest male sex is an independent predictor of postoperative complication risk and increased hospital stay after neurosurgical intervention. This finding may be used clinically to help identify those patients at increased risk of a complicated recovery. Future research might consider mechanisms relating sex and postoperative outcomes.
University of Michigan Medical School, Ann Arbor, Michigan, USA.
Matthew C
MC
Davis
Abdulrahman M
AM
El-Sayed
John E
JE
Ziewacz
Priya
P
Jayachandran
William C
WC
Geisert
Grettel J
GJ
Zamora-Berridi
Stephen E
SE
Sullivan
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D012727:Sex Characteristics