Jan Triebel1, Greta Snellman2, Bengt Sandén2, Fredrik Strömqvist3, Yohan Robinson4. 1. Department of Rheumatology, Stadtspital Triemli, Birmensdorferstrasse 497, 8063 Zürich, Switzerland; Department of Surgical Sciences, Uppsala University Hospital, 75185 Uppsala, Sweden. 2. Department of Surgical Sciences, Uppsala University Hospital, 75185 Uppsala, Sweden. 3. Department of Clinical Sciences and Orthopaedics, Skåne University Hospital, 20502 Malmö, Sweden. 4. Department of Surgical Sciences, Uppsala University Hospital, 75185 Uppsala, Sweden. Electronic address: yohan.robinson@surgsci.uu.se.
Abstract
BACKGROUND CONTEXT: Proper patient selection is of utmost importance in the surgical treatment of degenerative disc disease (DDD) with chronic low back pain (CLBP). Among other factors, gender was previously found to influence lumbar fusion surgery outcome. PURPOSE: This study investigates whether gender affects clinical outcome after lumbar fusion. STUDY DESIGN: This is a national registry cohort study. PATIENT SAMPLE: Between 2001 and 2011, 2,251 men and 2,521 women were followed prospectively within the Swedish National Spine Register (SWESPINE) after lumbar fusion surgery for DDD and CLBP. OUTCOME MEASURES: Patient-reported outcome measures (PROMs), visual analog scale (VAS) for leg and back pain, Oswestry Disability Index (ODI), quality of life (QoL) parameter EQ5D, and labor status and pain medication were collected preoperatively, 1 and 2 years after surgery. METHODS: Gender differences of baseline data and PROM improvement from baseline were analyzed. The effect of gender on clinically important improvement of PROM was determined in a multivariate logistic regression model. Furthermore, gender-related differences in return-to-work were investigated. RESULTS: Preoperatively, women had worse leg pain (p<.001), back pain (p=.002), lower QoL (p<.001), and greater disability than men (p=.001). Postoperatively, women presented greater improvement 2 years from baseline for pain, function, and QoL (all p<.01). Women had better chances of a clinically important improvement than men for leg pain (odds ratio [OR]=1.39, 95% confidence interval [CI]: 1.19-1.61, p<.01) and back pain (OR=1.20,95% CI:1.03-1.40, p=.02) as well as ODI (OR=1.24, 95% CI:1.05-1.47, p=.01), but improved at a slower pace in leg pain (p<.001), back pain (p=.009), and disability (p=.008). No gender differences were found in QoL and return to work at 2 years postoperatively. CONCLUSIONS: Swedish women do not have worse results than men after spinal fusion surgery. Female patients present with worse pain and function preoperatively, but improve more than men do after surgery.
BACKGROUND CONTEXT: Proper patient selection is of utmost importance in the surgical treatment of degenerative disc disease (DDD) with chronic low back pain (CLBP). Among other factors, gender was previously found to influence lumbar fusion surgery outcome. PURPOSE: This study investigates whether gender affects clinical outcome after lumbar fusion. STUDY DESIGN: This is a national registry cohort study. PATIENT SAMPLE: Between 2001 and 2011, 2,251 men and 2,521 women were followed prospectively within the Swedish National Spine Register (SWESPINE) after lumbar fusion surgery for DDD and CLBP. OUTCOME MEASURES: Patient-reported outcome measures (PROMs), visual analog scale (VAS) for leg and back pain, Oswestry Disability Index (ODI), quality of life (QoL) parameter EQ5D, and labor status and pain medication were collected preoperatively, 1 and 2 years after surgery. METHODS: Gender differences of baseline data and PROM improvement from baseline were analyzed. The effect of gender on clinically important improvement of PROM was determined in a multivariate logistic regression model. Furthermore, gender-related differences in return-to-work were investigated. RESULTS: Preoperatively, women had worse leg pain (p<.001), back pain (p=.002), lower QoL (p<.001), and greater disability than men (p=.001). Postoperatively, women presented greater improvement 2 years from baseline for pain, function, and QoL (all p<.01). Women had better chances of a clinically important improvement than men for leg pain (odds ratio [OR]=1.39, 95% confidence interval [CI]: 1.19-1.61, p<.01) and back pain (OR=1.20,95% CI:1.03-1.40, p=.02) as well as ODI (OR=1.24, 95% CI:1.05-1.47, p=.01), but improved at a slower pace in leg pain (p<.001), back pain (p=.009), and disability (p=.008). No gender differences were found in QoL and return to work at 2 years postoperatively. CONCLUSIONS: Swedish women do not have worse results than men after spinal fusion surgery. Female patients present with worse pain and function preoperatively, but improve more than men do after surgery.
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