Disparities Attributable to Sex Differences in 4680 Lumbar Fusion Outcomes.

IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY
World neurosurgery Pub Date : 2025-02-01 Epub Date: 2025-01-16 DOI:10.1016/j.wneu.2024.123586
Ritesh Karsalia, Ryan S Gallagher, Austin J Borja, Emily Xu, Jianbo Na, Scott D McClintock, Neil R Malhotra
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引用次数: 0

Abstract

Background: While studies have examined the relationship between sex and outcomes after lumbar fusion surgery, few have strictly controlled for other patient-level variables. In this study, we use coarsened exact matching (CEM) to determine the effect of patient-reported sex on spinal fusion outcomes.

Methods: Outcomes across 4680 consecutive adult single-level, posterior-only lumbar fusions at a multihospital academic medical center were retrospectively assessed. First, univariate analyses were performed to broadly examine the effect of sex on surgical outcomes, uncontrolled for other patient factors. Next, the population was split by sex (male vs. female) and matched 1:1 on demographic and medical factors known to influence outcomes (including age, race, smoking status, and past surgical history) using CEM. CEM effectively controls for confounding variable bias by creating pairs of matched samples and preserving the fidelity of each covariate through binning. Primary outcomes included 30-day and 90-day readmissions, emergency department visits, reoperations, and mortality. Secondary outcomes included discharge disposition and length of hospital stay.

Results: Between otherwise exactly matched male-female pairs, females were less likely to be discharged home (odds ratio 1.70, P < 0.001) and had a longer length of stay (mean: 95.7 vs. 87 hours, P < 0.001). No differences in readmissions or reoperations were observed between matched cohorts.

Conclusions: Female patients encountered longer hospital stays and higher odds of nonhome discharge after single-level lumbar fusion compared to otherwise exactly matched male patients.

4680例腰椎融合术结果的性别差异
背景:虽然有研究调查了性别与腰椎融合术后预后之间的关系,但很少有研究严格控制其他患者水平的变量。在这项研究中,我们使用粗化的精确匹配来确定患者报告的性别对脊柱融合结果的影响。方法:回顾性评估一家多医院学术医疗中心4680例连续成人单节段单纯后路腰椎融合术的结果。首先,进行了单变量分析,以广泛检查性别对手术结果的影响,不受其他患者因素的控制。接下来,按性别(男性与女性)划分人群,并使用粗化精确匹配(CEM)对已知影响结果的人口统计学和医学因素(包括年龄、种族、吸烟状况和既往手术史)进行1:1匹配。CEM通过创建匹配样本对,并通过分组保持每个协变量的保真度,有效地控制混淆变量偏差。主要结局包括30天和90天的再入院、急诊就诊、再手术和死亡率。次要结局包括出院情况和住院时间。结果:在完全匹配的男女患者中,女性出院回家的可能性更小(OR 1.70, p)。结论:与完全匹配的男性患者相比,女性患者在单节段腰椎融合术后住院时间更长,非家庭出院的几率更高。
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来源期刊
World neurosurgery
World neurosurgery CLINICAL NEUROLOGY-SURGERY
CiteScore
3.90
自引率
15.00%
发文量
1765
审稿时长
47 days
期刊介绍: World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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