Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan.
Departments of Pharmacy Practice, University of Kansas Medical Center, Kansas City, Kansas, USA.
Physiother Res Int. 2021 Apr;26(2):e1888. doi: 10.1002/pri.1888. Epub 2020 Dec 18.
Understanding the factors contributing to the variability in postoperative pain and function following lumbar spine surgeries (LSS) is necessary to plan inpatient rehabilitation and optimize surgical outcomes. In particular, variability due to age and gender has not been studied. This study's aim was to evaluate the variability in postoperative pain and function, during hospital stay, due to age and gender following LSS.
We conducted a retrospective analysis of 585 patients who underwent LSS during their hospital stay. Univariate ANCOVA was performed to study the differences in postoperative pain, and multivariate ANCOVA was performed to study the differences in postoperative function (gait distance, independency combined score, and balance combined score) between age groups (older adults [≥65 years of age] vs. younger adults) and gender.
Younger patients reported statistically, but not clinically, significant higher postoperative pain than older patients (β = 0.652 [95% CI (0.382-0.986)], p < 0.001), and males reported statistically, but not clinically, significant lower postoperative pain than female patients (β = -0.583 [95% CI (-0.825 to -0.252)], p < 0.001) with adjustment of covariates. Male patients walked significantly longer distance than female patients (β = 0.272 [95% CI (0.112-0.432)], p = 0.001) with adjustment of covariates. However, these were clinically insignificant. With adjustment of preoperative diagnosis, type of surgery, severity of illness, and prior level of function, there was no statistically significant difference between age groups in walking distance, and between age and gender groups in independency combined score and balance combined scores.
Following LSS, the difference in postoperative pain between age groups and gender are statistically but not clinically significant, suggesting patients require similar effective postoperative pain management regardless of age and gender. The apparent difference in age and gender in postoperative functional outcomes could be due to other factors.
了解导致腰椎脊柱手术后（LSS）术后疼痛和功能变化的因素对于规划住院康复和优化手术结果是必要的。特别是，由于年龄和性别导致的变异性尚未得到研究。本研究旨在评估 LSS 后患者在住院期间因年龄和性别导致的术后疼痛和功能的变异性。
我们对 585 例在住院期间接受 LSS 的患者进行了回顾性分析。采用单变量协方差分析（ANCOVA）研究年龄组（老年人[≥65 岁]与年轻人）和性别之间术后疼痛的差异，采用多变量协方差分析（ANCOVA）研究术后功能（步态距离、独立综合评分和平衡综合评分）的差异。
年轻患者报告的术后疼痛明显高于年长患者（β=0.652 [95%置信区间（0.382-0.986）]，p<0.001），但差异无临床意义，男性患者报告的术后疼痛明显低于女性患者（β=-0.583 [95%置信区间（-0.825 至-0.252）]，p<0.001），调整协变量后差异有统计学意义。调整协变量后，男性患者的步行距离明显长于女性患者（β=0.272 [95%置信区间（0.112-0.432）]，p=0.001），但差异无临床意义。调整术前诊断、手术类型、疾病严重程度和术前功能水平后，年龄组之间的步行距离、年龄和性别组之间的独立综合评分和平衡综合评分之间无统计学显著差异。
LSS 后，年龄组和性别之间的术后疼痛差异在统计学上但无临床意义，表明无论年龄和性别如何，患者都需要类似有效的术后疼痛管理。术后功能结果中年龄和性别之间的明显差异可能是由于其他因素造成的。
