gms | German Medical Science

Objectives: Among all age groups, women have a lower mortality rate than men, even though, according to the frailty index, they appear less healthy. This is known as the morbidity-mortality paradox and can be explained in a multifactorial approach considering anatomical, behavioral and social differences between the sexes. Consistent with this paradox, the risk of dying from heart disease and accidents is significantly higher for men than for women. Aim of this registry study was to evaluate, whether these gender-specific differences also apply for pelvic fractures and if there are gender-specific factors that could help explain this paradox.

Methods: Data from the German Pelvic Trauma Registry were evaluated retrospectively (n = 16.359). Gender-specific differences of the pelvic fractures were assessed with descriptive statistics. Furthermore, three logistic regression models with the dependent variables "Surgery", "Complication" and "Mortality" were established, and assessed with and without the independent variable "Gender" respectively.

Results: Women suffered from a pelvic fracture more often than men. Men were significantly younger (52.8±21.4 vs. 68.9±22.7 yrs.; p<0.05) and suffered significantly more serious injuries (ISS 17.0±12.4 vs. 12.1±10.3; p<0.05). Men sustained an acetabular fracture significantly more often than women (42.2% vs. 15.2%; p<0.05). Women with a pelvic fracture underwent significantly less operations for the pelvic fracture than men (adj. OR 0.58 [0.53-0.63]; p<0.05). Although the average age was much higher for female patients, their risk for complications is significantly lower (adj. OR 0.74 [0.67-0.82]; p<0.05), as well as the mortality rate (adj. OR 0.82 [0.68-0.98]; p<0.05). The accuracy of all three regression models is significantly better if the factor "gender" is included as an independent variable, and also the AIC (Akaike information criterion) is reduced in these cases.

Conclusion: In patients with pelvic fractures there are numerous significant differences between men and women that support and partly explain the morbidity-mortality paradox. In summary, women have a higher probability to sustain a pelvic fracture. However, the injury severity is lower in women compared to men and despite the older age, women have fewer complications and a lower mortality rate. In the three regression models we examined, the factor "gender" provides a significant contribution to the accuracy of the dependent variables "Surgery", "Complication" and "Mortality".