Sex-specific disparities in postoperative adverse events following intracranial tumor surgery: insights from a tertiary neurosurgical center

TL;DR

This study finds sex-specific differences in postoperative outcomes after brain tumor surgery, with women more likely to need intensive care and men having higher complication rates.

Contribution

The study identifies sex-specific disparities in postoperative adverse events following intracranial tumor surgery, emphasizing the need for gender-sensitive neurosurgical care.

Findings

Women were more likely to require unplanned ICU or IMC admission after surgery.

Men had higher crude rates of complications and revision surgeries.

After adjusting for confounders, male sex was associated with a modestly reduced risk of adverse events.

Abstract

Growing evidence suggests that patient sex may influence perioperative outcomes in neurosurgery, yet the extent to which gender differences shape morbidity following intracranial tumor resection remains unclear. Elucidating these disparities is essential for refining risk stratification, tailoring perioperative management, and improving resource allocation in neuro-oncological practice.

A prospective single-center observational study was performed between January 2023 and December 2023, enrolling all adult patients undergoing surgery for for intracranial mass lesions (neoplasms and tumor-like non-neoplastic inflammatory lesions). Perioperative data, including demographic variables, tumor pathology, and adverse events (AEs) within 30 days of surgery, were recorded in a standardized database. The Clavien–Dindo classification was used to grade AEs. Logistic regression identified independent predictors of AEs, adjusting for age, sex, tumor location, and surgical urgency.

Among 1173 patients (mean age 57.4 ± 15.3 years; 500 men, 673 women), men more frequently had gliomas (38.8% vs. 20.4%), whereas women exhibited significantly higher rates of meningiomas (41.8% vs. 28.2%) and neurinomas (8.8% vs. 4.2%; p < 0.05). Overall, 149 patients (12.7%) experienced one or more AEs. Men displayed a slightly higher unadjusted AE rate (14.0% vs. 11.7%) and revision rate (5.8% vs. 3.0%) without statistical significance. Women, however, required unplanned ICU or IMC admission more often (22.1% vs. 17.4%, p = 0.047). In the multivariable model, older age (p = 0.004), infratentorial tumor location (p = 0.017), and emergency surgery (p = 0.002) were independent risk factors for th occurrence of AE, while sex was not among the registered AEs.

These findings highlight sex‐specific differences in tumor distribution and postoperative outcomes in intracranial tumor surgery. Women were more likely to require escalated postoperative care, such as ICU or IMC admission, whereas men exhibited a higher crude rate of complications and revision surgeries. However, after adjusting for confounders such as age, tumor location, and surgical urgency, male sex was associated with a modestly reduced risk of adverse events, emphasizing the complex interplay of biological, clinical, and systemic factors in perioperative outcomes. Understanding these sex‐specific patterns is crucial for tailoring perioperative care strategies, improving patient outcomes, and advancing individualized treatment protocols in neuro-oncology. Further research should explore the underlying mechanisms driving these disparities to inform evidence-based, gender-sensitive neurosurgical care.

The online version contains supplementary material available at 10.1007/s00701-025-06708-z.