Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2021 Jun;150:e388-e399. doi: 10.1016/j.wneu.2021.03.025. Epub 2021 Mar 17.
Existing data have demonstrated significant differences in morbidity and mortality measures between men and women undergoing various spinal surgeries. However, studies of lumbar fusion surgery have been limited. Thus, we investigated the effects of patient sex on 30-day perioperative outcomes after elective lumbar fusion spine surgery.
Patients who had undergone lumbar fusion from 2015 to 2018 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program database. Propensity score matching was used to determine whether the patient's sex had influenced the 30-day perioperative complications.
A total of 44,526 cases had met the inclusion criteria and were reviewed. Of the 44,526 patients, 13,715 had undergone posterior lumbar fusion, 21,993 had undergone posterior/transforaminal lumbar interbody fusion, and 8818 had undergone anterior/lateral lumbar interbody fusion. The women were more likely to be older, functionally dependent, and taking steroids for chronic conditions and to have a higher body mass index and lower preoperative hematocrit level. The men were more likely to be white, to smoke, and to have diabetes mellitus, hypertension, and bleeding disorders. In all cohorts, except for a higher incidence of urinary tract infection in the female patients and myocardial infarction in the male patients, no significant differences were found in morbidity and mortality between the sexes.
Several differences in demographics and baseline health status were found between men and women undergoing lumbar fusion. When attempting to control for comorbid conditions using propensity score matching, we found that sex was an independent predictor of urinary tract infection in women and myocardial infarction in men across major morbidity and mortality categories in patients undergoing lumbar fusion surgery.
现有数据表明，男性和女性接受各种脊柱手术的发病率和死亡率存在显著差异。然而，腰椎融合手术的研究有限。因此，我们研究了患者性别对择期腰椎融合术后 30 天围手术期结局的影响。
从美国外科医师学会国家手术质量改进计划数据库中回顾了 2015 年至 2018 年接受腰椎融合术的患者。使用倾向评分匹配来确定患者性别是否影响 30 天围手术期并发症。
共有 44526 例符合纳入标准并进行了回顾。在 44526 例患者中，13715 例行后路腰椎融合术，21993 例行后路/经椎间孔腰椎体间融合术，8818 例行前路/外侧腰椎体间融合术。女性更可能年龄较大、功能依赖、因慢性疾病而服用类固醇，且体重指数较高、术前血细胞比容水平较低。男性更可能是白人、吸烟、患有糖尿病、高血压和出血性疾病。在所有队列中，除女性尿路感染发生率较高和男性心肌梗死发生率较高外，男女之间在发病率和死亡率方面没有发现显著差异。
在接受腰椎融合术的男性和女性之间，发现了一些在人口统计学和基线健康状况方面的差异。当试图使用倾向评分匹配来控制合并症时，我们发现性别是女性尿路感染和男性心肌梗死的独立预测因素，在接受腰椎融合手术的患者的主要发病率和死亡率类别中都是如此。
