RT Journal
A1 Wisner D
T1 Invited critique: Male gender is a risk factor for major infections after surgery
JF Archives of Surgery
JO Archives of Surgery
YR 1999
FD September 1
VO 134
IS 9
SP 940
OP 940
DO 10.1001/archsurg.134.9.940
UL http://dx.doi.org/10.1001/archsurg.134.9.940
AB 
The study is well conceived and well done. It is important to note, however, that there were no differences with respect to clinical outcome parameters (mortality, intensive care unit or hospital length of stay) between males and females despite a significant difference in major infection rates. The rates of multiple organ failure were also similar between male and female patients, perhaps surprising given that major infection is one of the stimuli that can lead to multiple organ failure. A type II error is one potential explanation for the absence of differences in clinical outcome. Another possibility is that major infection as defined by the authors (particularly the definition of pneumonia) was not restrictive enough to select patients in whom infection affected outcome. Finally, it is also possible that immunosuppression is not always detrimental after major trauma; a vigorous immune response can injure the host as much or more than the inciting insult.