Elsamadicy Aladine A, Reddy Gireesh B, Nayar Gautum, Sergesketter Amanda, Zakare-Fagbamila Rasheedat, Karikari Isaac O, Gottfried Oren N
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
World Neurosurg. 2017 Nov;107:952-958. doi: 10.1016/j.wneu.2017.07.082. Epub 2017 Jul 23.
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.
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.
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).
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.
关于性别差异对脊柱手术结果，尤其是健康认知和满意度的影响，现有数据较少。本研究旨在确定择期腰椎手术后3个月和1年患者报告的结果及满意度是否存在差异。
这是一项对384例行择期腰椎手术患者的前瞻性数据库进行回顾性分析的研究。患者按性别分类（男性，n = 199；女性，n = 185）。患者报告的结果指标（Oswestry功能障碍指数、视觉模拟评分法-背痛/腿痛、欧洲五维度健康量表视觉模拟评分法和欧洲五维度健康量表问卷）在手术前完成，然后在术后3个月和12个月完成，同时进行患者满意度测量。
两个队列的基线患者人口统计学、合并症和手术变量相似。女性队列的住院时间略长于男性队列（P = 0.007）。两个队列的基线患者报告的结果测量不同，女性患者的Oswestry功能障碍指数更高（23.8对20.4；P≤0.0001）、视觉模拟评分法-背痛更高（7.2对6.2；P = 0.0004），与男性队列相比，欧洲五维度健康量表问卷得分更低（0.34对0.49；P = 0.0001）。在1年随访时，男性队列在视觉模拟评分法-腿痛方面的平均变化显著更大（-3.9对-2.8；P = 0.04），在视觉模拟评分法-背痛方面的平均变化有更大趋势（-3.4对-2.5；P = 0.06），欧洲五维度健康量表视觉模拟评分法得分也更高（8.6对3.4；P = 0.054）。在1年时，与女性队列相比，男性队列中认为手术符合其期望的比例显著更高（65.0%对49.5%；P = 0.02）。
我们的研究表明，在基线、短期和长期随访中，男性和女性在健康认知、疼痛和功能障碍方面可能存在差异，这可能会影响患者的总体满意度。
