Gender Disparities in Morbidity and Mortality Following Traumatic Brain Injury Surgical Procedures

Background: Traumatic brain injury (TBI) is a Major contributor to morbidity and mortality in the United States. Although prior research has suggested potential gender differences in TBI outcomes, limited data exist on surgical cohorts. This study aimed to evaluate gender-based disparities in postoperative complications and 30-day outcomes following surgical management of TBI using a large national surgical registry. Methods: A retrospective cohort study was performed using the 2023 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Adults (≥ 18 years) who underwent surgical intervention for TBI were identified using Current Procedural Terminology codes. Patients were stratified by gender, and comparisons were made using Wilcoxon rank-sum and χ² tests. Multivariate logistic regression was conducted to assess independent predictors of 30-day morbidity and mortality. Results: Of the 2,519 patients, 64.8% were Male and 35.2% were female. Female patients were significantly older (70.9 ± 14.6 vs. 67.2 ± 16.0 years, p < 0.001) and had higher rates of hypertension (65.1% vs. 58.1%, p < 0.001), bleeding disorders (25.5% vs. 19.4%, p < 0.001), and frailty (modified frailty index ≥ 2 in 31.0% vs. 28.6%, p < 0.001). Additionally, postoperative urinary tract infections (odds ratio [OR] 2.35, 95% confidence interval [CI] 1.56–3.55, p < 0.001), transfusion requirement (OR 1.67, 95% CI 1.34–2.08, p < 0.001), and 30-day morbidity (OR 1.29, 95% CI 1.10–1.52, p = 0.002) were significantly higher in female patients. Multivariate analysis confirmed female gender as an independent predictor of 30-day morbidity (OR 1.31, 95% CI 1.02–1.68, p = 0.034). No significant difference in 30-day mortality between male and female patients was observed (OR 1.08, 95% CI 0.87–1.33, p = 0.493). Conclusions: Female patients undergoing surgical treatment for TBI experience significantly higher postoperative morbidity despite comparable mortality. Increased age, comorbidity burden, and complication rates in female patients underscore the need for gender-specific perioperative strategies. Limitations include the 30-day follow-up window and retrospective design. These findings support further investigation into tailored interventions to mitigate gender disparities in neurosurgical care.