Sex disparities in adverse outcomes after surgically managed isolated traumatic spinal injury
European Journal of Trauma and Emergency Surgery - Trang 1-7 - 2023
Tóm tắt
Traumatic spinal injury (TSI) encompasses a wide range of injuries affecting the spinal cord, nerve roots, bones, and soft tissues that result in pain, impaired mobility, paralysis, and death. There is some evidence suggesting that women may have different physiological responses to traumatic injury compared to men; therefore, this study aimed to investigate if there are any associations between sex and adverse outcomes following surgically managed isolated TSI. Using the 2013–2019 TQIP database, all adult patients with isolated TSI, defined as a spine AIS ≥ 2 with an AIS ≤ 1 in all other body regions, resulting from blunt force trauma requiring spinal surgery, were eligible for inclusion in the study. The association between the sex and in-hospital mortality as well as cardiopulmonary and venothromboembolic complications was determined by calculating the risk ratio (RR) after adjusting for potential confounding using inverse probability weighting. A total of 43,756 patients were included. After adjusting for potential confounders, female sex was associated with a 37% lower risk of in-hospital mortality [adjusted RR (95% CI): 0.63 (0.57–0.69), p < 0.001], a 27% lower risk of myocardial infarction [adjusted RR (95% CI): 0.73 (0.56–0.95), p = 0.021], a 37% lower risk of cardiac arrest [adjusted RR (95% CI): 0.63 (0.55–0.72), p < 0.001], a 34% lower risk of deep vein thrombosis [adjusted RR (95% CI): 0.66 (0.59–0.74), p < 0.001], a 45% lower risk of pulmonary embolism [adjusted RR (95% CI): 0.55 (0.46–0.65), p < 0.001], a 36% lower risk of acute respiratory distress syndrome [adjusted RR (95% CI): 0.64 (0.54–0.76), p < 0.001], a 34% lower risk of pneumonia [adjusted RR (95% CI): 0.66 (0.60–0.72), p < 0.001], and a 22% lower risk of surgical site infection [adjusted RR (95% CI): 0.78 (0.62–0.98), p < 0.032], compared to male sex. Female sex is associated with a significantly decreased risk of in-hospital mortality as well as cardiopulmonary and venothromboembolic complications following surgical management of traumatic spinal injuries. Further studies are needed to elucidate the cause of these differences.
Tài liệu tham khảo
Kumar R, Lim J, Mekary RA, Rattani A, Dewan MC, Sharif SY, et al. Traumatic spinal injury: global epidemiology and worldwide volume. World Neurosurg. 2018;113:e345–63.
Choudhry MA, Bland KI, Chaudry IH. Trauma and immune response–effect of gender differences. Injury. 2007;38(12):1382–91.
Sperry JL, Nathens AB, Frankel HL, Vanek SL, Moore EE, Maier RV, et al. Characterization of the gender dimorphism after injury and hemorrhagic shock: are hormonal differences responsible? Crit Care Med. 2008;36(6):1838–45.
Angele MK, Frantz MC, Chaudry IH. Gender and sex hormones influence the response to trauma and sepsis: potential therapeutic approaches. Clin Sao Paulo Braz. 2006;61(5):479–88.
Knöferl MW, Angele MK, Diodato MD, Schwacha MG, Ayala A, Cioffi WG, et al. Female sex hormones regulate macrophage function after trauma-hemorrhage and prevent increased death rate from subsequent sepsis. Ann Surg. 2002;235(1):105–12.
Magnotti LJ, Fischer PE, Zarzaur BL, Fabian TC, Croce MA. Impact of gender on outcomes after blunt injury: a definitive analysis of more than 36,000 trauma patients. J Am Coll Surg. 2008;206(5):984–91 (discussion 991–992).
Trentzsch H, Nienaber U, Behnke M, Lefering R, Piltz S. Female sex protects from organ failure and sepsis after major trauma haemorrhage. Injury. 2014;45(Suppl 3):S20-28.
Yang KC, Zhou MJ, Sperry JL, Rong L, Zhu XG, Geng L, et al. Significant sex-based outcome differences in severely injured Chinese trauma patients. Shock Augusta Ga. 2014;42(1):11–5.
Frink M, Pape HC, van Griensven M, Krettek C, Chaudry IH, Hildebrand F. Influence of sex and age on mods and cytokines after multiple injuries. Shock Augusta Ga. 2007;27(2):151–6.
Pape M, Giannakópoulos GF, Zuidema WP, de Lange-Klerk ESM, Toor EJ, Edwards MJR, et al. Is there an association between female gender and outcome in severe trauma? A multi-center analysis in the Netherlands. Scand J Trauma Resusc Emerg Med. 2019;27(1):16.
Furlan JC, Shen T, Kurban D. Sex-related discrepancies in the access to optimal care and outcomes after traumatic spinal cord injury: a retrospective cohort study using data from a Canadian Registry. Arch Phys Med Rehabil. 2023;104(1):1–10.
Furlan JC, Craven BC, Fehlings MG. Sex-related discrepancies in the epidemiology, injury characteristics and outcomes after acute spine trauma: a retrospective cohort study. J Spinal Cord Med. 2019;42(sup1):10–20.
Furlan JC, Krassioukov AV, Fehlings MG. The effects of gender on clinical and neurological outcomes after acute cervical spinal cord injury. J Neurotrauma. 2005;22(3):368–81.
Noe BB, Stapelfeldt CM, Parner ET, Mikkelsen EM. Survival after traumatic spinal cord injury in Denmark: a hospital-based study among patients injured in 1990–2012. Spinal Cord. 2017;55(4):373–7.
Chamberlain JD, Deriaz O, Hund-Georgiadis M, Meier S, Scheel-Sailer A, Schubert M, et al. Epidemiology and contemporary risk profile of traumatic spinal cord injury in Switzerland. Inj Epidemiol. 2015;2(1):28.
Hatch BB, Wood-Wentz CM, Therneau TM, Walker MG, Payne JM, Reeves RK. Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury. Spinal Cord. 2017;55(6):540–4.
Shibahashi K, Nishida M, Okura Y, Hamabe Y. Epidemiological state, predictors of early mortality, and predictive models for traumatic spinal cord injury: a multicenter nationwide cohort study. Spine. 2019;44(7):479–87.
Wang Y, Guo Z, Fan D, Lu H, Xie D, Zhang D, et al. A meta-analysis of the influencing factors for tracheostomy after cervical spinal cord injury. BioMed Res Int. 2018;2018:5895830.
WMA - The World Medical Association-WMA Declaration of Helsinki—ethical principles for medical research involving human subjects [Internet]. [citerad 21 september 2020]. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/. Accessed 30 Nov 2022.
Morris JA, Gardner MJ. Calculating confidence intervals for relative risks (odds ratios) and standardised ratios and rates. Br Med J Clin Res Ed. 1988;296(6632):1313–6.
R Development Core Team. R: a language and environment for statistical computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2008. Available from: http://www.R-project.org/. Accessed 30 Nov 2022.
Bösch F, Angele MK, Chaudry IH. Gender differences in trauma, shock and sepsis. Mil Med Res. 2018;5(1):35.
Hubbard W, Keith J, Berman J, Miller M, Scott C, Peck C, et al. 17α-Ethynylestradiol-3-sulfate treatment of severe blood loss in rats. J Surg Res. 2015;193(1):355–60.
Miller M, Keith J, Berman J, Burlington DB, Grudzinskas C, Hubbard W, et al. Efficacy of 17α-ethynylestradiol-3-sulfate for severe hemorrhage in minipigs in the absence of fluid resuscitation. J Trauma Acute Care Surg. 2014;76(6):1409–16.
Li T, Xiao X, Zhang J, Zhu Y, Hu Y, Zang J, et al. Age and sex differences in vascular responsiveness in healthy and trauma patients: contribution of estrogen receptor-mediated Rho kinase and PKC pathways. Am J Physiol Heart Circ Physiol. 2014;306(8):H1105-1115.
Soliman M. Protective effects of estradiol on myocardial contractile function following hemorrhagic shock and resuscitation in rats. Chin Med J (Engl). 2015;128(17):2360–4.
Dhamad AE, Zhou Z, Zhou J, Du Y. Systematic proteomic identification of the heat shock proteins (Hsp) that interact with estrogen receptor alpha (ERα) and biochemical characterization of the ERα-Hsp70 interaction. PLoS ONE. 2016;11(8): e0160312.
Wang JL, Ke DS, Lin MT. Heat shock pretreatment may protect against heatstroke-induced circulatory shock and cerebral ischemia by reducing oxidative stress and energy depletion. Shock Augusta Ga. 2005;23(2):161–7.
Hsu JT, Hsieh YC, Kan WH, Chen JG, Choudhry MA, Schwacha MG, et al. Role of p38 mitogen-activated protein kinase pathway in estrogen-mediated cardioprotection following trauma-hemorrhage. Am J Physiol Heart Circ Physiol. 2007;292(6):H2982-2987.
Szalay L, Shimizu T, Suzuki T, Yu HP, Choudhry MA, Schwacha MG, et al. Estradiol improves cardiac and hepatic function after trauma-hemorrhage: role of enhanced heat shock protein expression. Am J Physiol Regul Integr Comp Physiol. 2006;290(3):R812-818.
Yu HP, Shimizu T, Choudhry MA, Hsieh YC, Suzuki T, Bland KI, et al. Mechanism of cardioprotection following trauma-hemorrhagic shock by a selective estrogen receptor-beta agonist: up-regulation of cardiac heat shock factor-1 and heat shock proteins. J Mol Cell Cardiol. 2006;40(1):185–94.
Baue AE. MOF, MODS, and SIRS: what is in a name or an acronym? Shock Augusta Ga. 2006;26(5):438–49.
Shukla A, Hashiguchi N, Chen Y, Coimbra R, Hoyt DB, Junger WG. Osmotic regulation of cell function and possible clinical applications. Shock Augusta Ga. 2004;21(5):391–400.
Ulloa L, Tracey KJ. The ”cytokine profile”: a code for sepsis. Trends Mol Med. 2005;11(2):56–63.
Haider AH, Crompton JG, Oyetunji T, Stevens KA, Efron DT, Kieninger AN, et al. 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. Surgery. 2009;146(2):308–15.
Gannon CJ, Pasquale M, Tracy JK, McCarter RJ, Napolitano LM. Male gender is associated with increased risk for postinjury pneumonia. Shock Augusta Ga. 2004;21(5):410–4.