biostudies-literatureLian QShenzhen Medical Research Fund146https://www.ebi.ac.uk/biostudies/studies/S-EPMC12914919biostudies-literatureUnknown26(1)<h4>Background</h4>The "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.<h4>Methods</h4>A retrospective cohort study was conducted using the US National Inpatient Sample (2005-2014) A frailty-defining diagnosis cluster was employed to identify frail individualsBMC surgeryThe "male-female health-survival paradox" in frail patients undergoing hip replacement.PMC12914919A2402016C2501025Li GDu DLian YWang JLian QYu YfalseThe "male-female health-survival paradox" in frail patients undergoing hip replacement.<h4>Background</h4>The "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.<h4>Methods</h4>A retrospective cohort study was conducted using the US National Inpatient Sample (2005-2014) A frailty-defining diagnosis cluster was employed to identify frail individuals2026-01-01T00:00:00Z2026 Jan2026-07-16T06:33:41.005Z2026-07-09T10:39:14.877ZS-EPMC129149194158072310.1186/s12893-026-03532-9