Original ArticleImpact of Gender Disparities on Short-Term and Long-Term Patient Reported Outcomes and Satisfaction Measures After Elective Lumbar Spine Surgery: A Single Institutional Study of 384 Patients
Introduction
The advent of the Patient Protection and Affordable Care Act (PPACA) brought an increased emphasis on patient-reported outcomes (PROs) and satisfaction measures as proxies of overall quality of care and determinants of hospital reimbursements. As a result, the identification of disparities or demographics that may influence postoperative outcomes and PROs have become important in surgical fields to interpret satisfaction measure results and implement quality improvement initiatives.1 Gender disparities have been shown to be significant determinant of PROs with several studies demonstrating that women report inferior PROs, including health-related quality of life and satisfaction, after medical2, 3, 4, 5, 6 and surgical interventions, including vascular,7 orthopedic,8 and oncologic surgeries.9
In spine surgery, gender disparities have been identified to affect delivery of care after surgery and postoperative complications. Furthermore, these disparities have been shown to affect the management of low back pain, including decisions to obtain imaging and pursue surgery.10 Previous studies have demonstrated that women are associated with an increased risk of postoperative complications, hospital length of stay (LOS), and mortality after undergoing elective spinal surgery.11, 12 However, there remains a paucity of data on the impact of gender disparities on short-term and long-term PROs and satisfaction measures after spine surgery.
The aim of this study was to determine whether there is a difference between men and women in 3-month and 1-year PROs and satisfaction measures after elective spine surgery.
Section snippets
Methods
In this retrospectively study from a maintained prospective database, the medical records of 384 patients who underwent elective lumbar spine surgery at a major academic institution were reviewed from 2012 to 2016. Institutional Review Board approval was obtained before study initiation. Indications for lumbar spine surgery included lumbar spondylolisthesis (grade 1), symptomatic lumbar disc herniation, lumbar stenosis, lumbar adjacent segment disease, scoliosis and/or kyphosis. Inclusion
Demographics and Comorbidities
A total of 384 patients (199 men and 185 women) were included in this retrospective study. Baseline characteristics were similar between cohorts, apart from a higher prevalence of coronary artery disease (12.6% vs. 5.4%) among the male cohort (Table 1). There were no significant differences in age (male cohort, 58.7 ± 12.7 years vs. female –cohort, 56.6 ± 13.9 years; P = 0.13) or body mass index (male cohort, 30.0 ± 5.4 kg/m2 vs. female cohort, 31.1 ± 7.4 kg/m2; P = 0.12) between cohorts (
Discussion
In this retrospective cohort study of 384 patients undergoing elective spine surgery, our study suggests that gender disparities may play a role in short-term and long-term PROs and patient satisfaction measures.
Baseline PROs have been shown to be poorer among women undergoing spine surgery. In a study of back pain among 34,902 individuals, representative of the general Danish population, Leboeuf-Yde et al13 showed that women were not only more likely than men to report back pain, but were also
Conclusion
Our study suggests that there may be differences in perception of health, pain, and disability between men and women at baseline, short-term and long-term follow-up, which may influence overall patient satisfaction. Further studies are necessary to identify patient-specific factors associated with gender disparities that may be influencing outcomes to adequately measure and assess overall PROs and satisfaction after surgery.
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2022, World NeurosurgeryCitation Excerpt :The minimal clinically important difference (MCID) achievement rates, which denote the smallest detectable improvement for an outcome a patient believes is meaningful, were also recorded. Previous studies have investigated the influence of self-identified gender on postoperative clinical outcomes after elective spine surgery.6 The purpose of the present study was to further elucidate the possible differences between men and women in their perceptions of health, pain, and disability at baseline and at short- and long-term follow-up after MILD.
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.