Elsevier

World Neurosurgery

Volume 107, November 2017, Pages 952-958
World Neurosurgery

Original Article
Impact 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

https://doi.org/10.1016/j.wneu.2017.07.082Get rights and content

Background

There is a paucity of data determining the impact that gender disparities have on spine outcomes, particularly perception of health and satisfaction. The aim of this study was to determine whether there is a difference in 3-month and 1-year patient-reported outcomes and satisfaction after elective lumbar spine surgery.

Methods

This was a retrospectively analyzed study from a maintained prospective database of 384 patients who underwent elective lumbar spine surgery. Patients were categorized by gender (men, n = 199; women, n = 185). Patient-reported outcome instruments (Oswestry disability index, visual analogue scale-back pain/leg pain, EuroQol visual analogue scale, and EuroQol 5 dimensions questionnaire) were completed before surgery, then at 3 and 12 months after surgery along with patient satisfaction measures.

Results

Baseline patient demographics, comorbidities, and operative variables were similar between both cohorts. The female cohort had a slightly longer hospital stay than male cohort (P = 0.007). Baseline patient-reported outcome measures were different between both cohorts, with female patients having more Oswestry disability index (23.8 vs. 20.4; P ≤ 0.0001) and visual analogue scale-back pain (7.2 vs. 6.2; P = 0.0004), and a lower EuroQol 5 dimensions questionnaire (0.34 vs. 0.49; P = 0.0001) compared with the male cohort. At 1-year follow-up, the male cohort had a significantly more mean change in visual analogue scale-leg pain (−3.9 vs. −2.8; P = 0.04) and trended to have more mean change in visual analogue scale-back pain (−3.4 vs. −2.5; P = 0.06) and EuroQol visual analogue scale (8.6 vs. 3.4; P = 0.054) scores compared with the female cohort. At 1-year a significantly more portion in the male cohort found that surgery met their expectations compared with the female cohort (65.0% vs. 49.5%; P = 0.02).

Conclusions

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 that may influence overall patient satisfaction.

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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    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.

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