Sex-Specific Differences in Risk Factors and Outcomes for Long-Term Mechanical Ventilation: A Longitudinal Cohort Analysis of Claims Data

<bold>Background:</bold> Sex is an important yet underappreciated factor in intensive care, particularly in the context of weaning. This study aimed to investigate sex-specific differences in risk factors associated with long-term mechanical ventilation (MV). <bold>Methods:</bold> We analysed AOK Baden-Württemberg insurance data of patients aged ≥30y, with at least one comorbidity, who received MV (≥96 hours), discharged in 2015-18, with claims data covering 365 days before hospitalisation and 30 days after discharge. Sex differences in predefined risk factors were assessed using group comparisons and regression analysis. <bold>Results:</bold> More than 12,000 hospitalisations were analysed and 37.8% of patients were female. Women were older (71.3±11.6vs.69.9±11.2y, p<0.001), but men more often required invasive long-term ventilation (33.8%vs.31.2%, p=0.004) and had more hours of ventilation (400.0±377.9vs.373.0±341.8, p<0.001). In addition to differences in the prevalence of risk factors, the impact of certain risk factors on long-term MV also differed significantly between the sexes. In men, thyroiditis (OR 2.7 vs. 1.4 in women), cerebral infarction (OR 2.3vs.1.4) and acute pancreatitis (OR 3.2vs.1.0) significantly increased the risk of weaning failure. In women, Cerebrospinal fluid surgery (OR 5.7 vs. 2.0 in men) and acute pancreatitis (OR 4.7vs.3.0) were strongly associated with long-term MV. In addition, some factors, such as ECLS and eating disorders, were only associated with long-term ventilation in men. <bold>Conclusion:</bold> These findings emphasize the need to account for sex-specific considerations in the management of patients requiring prolonged MV.