Karsalia Ritesh, Gallagher Ryan S, Borja Austin J, Xu Emily, Na Jianbo, McClintock Scott D, Malhotra Neil R
Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; McKenna EpiLog Fellowship in Population Health, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2025 Feb;194:123586. doi: 10.1016/j.wneu.2024.123586. Epub 2025 Jan 16.
While studies have examined the relationship between sex and outcomes after lumbar fusion surgery, few have strictly controlled for other patient-level variables. In this study, we use coarsened exact matching (CEM) to determine the effect of patient-reported sex on spinal fusion outcomes.
Outcomes across 4680 consecutive adult single-level, posterior-only lumbar fusions at a multihospital academic medical center were retrospectively assessed. First, univariate analyses were performed to broadly examine the effect of sex on surgical outcomes, uncontrolled for other patient factors. Next, the population was split by sex (male vs. female) and matched 1:1 on demographic and medical factors known to influence outcomes (including age, race, smoking status, and past surgical history) using CEM. CEM effectively controls for confounding variable bias by creating pairs of matched samples and preserving the fidelity of each covariate through binning. Primary outcomes included 30-day and 90-day readmissions, emergency department visits, reoperations, and mortality. Secondary outcomes included discharge disposition and length of hospital stay.
Between otherwise exactly matched male-female pairs, females were less likely to be discharged home (odds ratio 1.70, P < 0.001) and had a longer length of stay (mean: 95.7 vs. 87 hours, P < 0.001). No differences in readmissions or reoperations were observed between matched cohorts.
Female patients encountered longer hospital stays and higher odds of nonhome discharge after single-level lumbar fusion compared to otherwise exactly matched male patients.
虽然已有研究探讨了性别与腰椎融合手术后结局之间的关系，但很少有研究严格控制其他患者层面的变量。在本研究中，我们使用粗化精确匹配（CEM）来确定患者报告的性别对脊柱融合结局的影响。
回顾性评估了一家多医院学术医疗中心连续进行的4680例成人单节段、仅后路腰椎融合手术的结局。首先，进行单因素分析以广泛检查性别对手术结局的影响，未控制其他患者因素。接下来，按性别（男性与女性）将人群分开，并使用CEM在已知会影响结局的人口统计学和医学因素（包括年龄、种族、吸烟状况和既往手术史）上进行1:1匹配。CEM通过创建匹配样本对并通过分箱保留每个协变量的保真度，有效地控制了混杂变量偏差。主要结局包括30天和90天再入院、急诊就诊、再次手术和死亡率。次要结局包括出院处置和住院时间。
在其他方面完全匹配的男女对中，女性出院回家的可能性较小（优势比1.70，P < 0.001），住院时间更长（平均：95.7小时对87小时，P < 0.001）。在匹配队列之间未观察到再入院或再次手术的差异。
与其他方面完全匹配的男性患者相比，女性患者在单节段腰椎融合术后住院时间更长，非回家出院的几率更高。
