ArticleBMC surgery2026
The "male-female health-survival paradox" in frail patients undergoing hip replacement.
Article in BMC surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe "male-female health-survival paradox" describes women's longer lifespan despite a greater burden of non-fatal chronic conditions-a phenomenon rarely examined in surgical settings. This study investigated whether this paradox exists in a national cohort of frail patients undergoing hip replacement and explored its underlying mechanisms. We hypothesized that in this cohort: (1) female patients would be less healthy, presenting with a higher prevalence of frailty, older age, and a higher Charlson Comorbidity Index (CCI); and (2) frail men would experience higher in-hospital mortality.
methodsA retrospective cohort study was conducted using the US National Inpatient Sample (2005-2014) A frailty-defining diagnosis cluster was employed to identify frail individuals. Sex-based differences in demographics, comorbidities, and in-hospital outcomes (mortality, complications, length of stay, costs) were analyzed using multivariable logistic regression, including interaction terms and sex-stratified models.
resultAmong 29,063 frail patients, 64% were female. Despite being significantly older (median age 81 vs. 77 years, p < 0.001) and having a higher CCI burden, frail women had significantly lower in-hospital mortality than men (3% vs. 5%, p < 0.001). Comorbidity patterns differed markedly: women had higher rates of rheumatoid arthritis, depression, and hypothyroidism, while men had more congestive heart failure, diabetes, and renal failure (all p < 0.001). After adjustment, male sex remained an independent predictor of mortality (Adjusted OR 1.31, 95% CI 1.15-1.49, p < 0.001), primarily driven by significant interactions between male sex and life-threatening conditions such as heart failure and renal failure.
conclusionThe male-female health-survival paradox is evident in frail patients undergoing hip replacement. These findings highlight the need for sex-tailored preoperative optimization, with particular emphasis on cardiovascular and metabolic risk management in frail male patients.
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