ThinkFirst Award - Investigating Gender Disparities as a Predictor of Morbidity and Mortality in Traumatic Brain Injury: A Cohort Analysis

Introduction: Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide, influencing patient outcomes significantly. This study explores gender disparities in a diverse cohort of TBI patients, focusing on mortality and morbidity in males and females.

Methods: We utilized the ACS-NSQIP dataset to identify patients who underwent craniectomy for Traumatic Brain Injury as a primary procedure from 2016 to 2021. We selected cases using specific CPT codes: 61304, 61305, 61312, 61306, 61345, 61320, 61322, 61100, and 61321. Additional filters were applied using TBI-related diagnoses based on ICD-10 codes to refine our cohort further. T-tests were used to compare continuous variables and Chi-Squared tests for categorical variables. Univariate analysis assessed the association between gender disparities and the incidence of postoperative complications and mortality.

Results: The sample consisted of 2,519 patients with 1,633 males (64.82%) and 886 females (35.17%), mean age of 67.21 years for males (SD = 16.05) and 70.85 years for females (SD = 14.57); the mean BMI was 26.99 for males (SD = 5.40) and 26.45 for females (SD 6.24). The modified frailty index (MFI) was split into 3 categories: 0 (no frailty), 1 (moderate frailty), and ≥ 2 (severe frailty). The analysis of frailty revealed that 42.2% females presented MFI of 1 compared to 37.2% for males; and 31% females presented MFI of 2 compared to 28.6% males (p < 0.001). Among females, 44.9% experienced an increased 30-day morbidity rate compared to 38.7% for males (p = 0.002). No significant differences were seen in rates of mortality between genders.

Conclusion : The study suggests that, while mortality holds consistent, there are significant gender disparities regarding morbidity within TBI patients. Female patients showed higher rates of 30-day morbidity compared to males. These findings emphasize the importance of taking into consideration gender disparities in the management and outcomes of TBI. Future studies are essential to providing more robust evaluation of gender disparities and refining management strategies for TBI.