Hartman Timothy J, Nie James W, MacGregor Keith R, Oyetayo Omolabake O, Zheng Eileen, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
J Clin Orthop Trauma. 2022 Sep 11;34:102019. doi: 10.1016/j.jcot.2022.102019. eCollection 2022 Nov.
There have been a multitude of studies attempting to identify the relationship between gender and postoperative outcomes; however, few studies have examined how this relationship may affect outcomes after anterior lumbar interbody fusion (ALIF) surgery. We aim to better characterize the impact that self-reported gender may have on patient reported outcome measures (PROMs) and achievement rates of minimum clinically important difference (MCID) after ALIF.
A retrospective database of a single spine surgeon was searched for patients who had undergone single-level ALIF. Indications for surgery including acute trauma, infection, or malignancy were excluded. The population was separated into cohorts by self-reported gender, female or male. PROMs were recorded and compared within groups to their preoperative baselines and between groups. MCID achievement rate was compared between groups.
140 patients were identified for this study, with 68 patients self-identifying as female gender. The male gender cohort was found to have a significantly greater prevalence of hypertension (p = 0.018). Both cohorts showed significant improvement during at least one or more postoperative time points for each evaluated outcome measure (p ≤ 0.048, all). No significant difference in mean PROM scores was noted between cohorts at any time point for any measured outcome. The female gender cohort had significantly greater MCID achievement rates for visual acuity scale (VAS) back pain overall and at the 6-month time point (p ≤ 0.043, both). The female gender cohort also had significantly greater achievement of MCID at the 1-year time point for VAS leg pain (p = 0.017).
Both female and male gender cohorts demonstrated significant improvement in all outcomes measured at one or more postoperative time points. Postoperative outcomes did not differ by gender. MCID achievement was more common in female patients. Female patients may experience more tangible clinical improvement after ALIF compared to male patients.
已有大量研究试图确定性别与术后结果之间的关系；然而，很少有研究探讨这种关系如何影响腰椎前路椎间融合术（ALIF）后的结果。我们旨在更好地描述自我报告的性别对ALIF术后患者报告结局量表（PROMs）和最小临床重要差异（MCID）达成率的影响。
在一位脊柱外科医生的回顾性数据库中搜索接受单节段ALIF手术的患者。排除包括急性创伤、感染或恶性肿瘤等手术指征。根据自我报告的性别将人群分为女性或男性队列。记录PROMs并在组内与术前基线进行比较，以及在组间进行比较。比较组间的MCID达成率。
本研究共纳入140例患者，其中68例自我认定为女性。发现男性队列中高血压患病率显著更高（p = 0.018）。两个队列在每个评估结局指标的至少一个或多个术后时间点均显示出显著改善（p≤0.048，均如此）。在任何时间点，任何测量结局的组间平均PROM评分均未发现显著差异。女性队列在总体和6个月时间点的视觉模拟量表（VAS）背痛MCID达成率显著更高（p≤0.043，两者均如此）。女性队列在1年时间点的VAS腿痛MCID达成率也显著更高（p = 0.017）。
女性和男性队列在术后一个或多个时间点测量的所有结局中均显示出显著改善。术后结局不存在性别差异。MCID达成在女性患者中更为常见。与男性患者相比，女性患者在ALIF术后可能经历更明显的临床改善。
