Effect of patient's sex on early perioperative outcomes following anterior cervical discectomy and fusion

Safwan Alomari; Ann Liu; Erick Westbroek; Timothy Witham; Ali Bydon; Sheng-Fu Larry Lo

doi:10.1016/j.jocn.2021.09.015

Effect of patient's sex on early perioperative outcomes following anterior cervical discectomy and fusion

J Clin Neurosci. 2021 Nov:93:247-252. doi: 10.1016/j.jocn.2021.09.015. Epub 2021 Sep 27.

Authors

Safwan Alomari¹, Ann Liu², Erick Westbroek³, Timothy Witham⁴, Ali Bydon⁵, Sheng-Fu Larry Lo⁶

Affiliations

¹ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: salomar1@jhmi.edu.
² Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: aliu40@jhmi.edu.
³ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: erickw@jhmi.edu.
⁴ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: twitham2@jhmi.edu.
⁵ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: abydon1@jhmi.edu.
⁶ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: larrylo@northwell.edu.

PMID: 34656256
DOI: 10.1016/j.jocn.2021.09.015

Abstract

Objective: Differences in morbidity and mortality measures between males and females have been demonstrated for a variety of spinal surgeries, however, studies of anterior cervical discectomy and fusion (ACDF) are limited. To investigate the impact ofsexon 30-day perioperative outcomes of ACDF.

Methods: Retrospective 1:1 propensity score-matched cohort study. Patients who underwent ACDF between 2016 and 2018 were reviewed from the ACS-NSQIP database.Propensity score matchingand subgroup analysis were used.

Results: 21,180 patients met inclusion criteria. 11,194 patients underwent single-level ACDF and 9986 patients underwent multi-level ACDF. In the single-level group, there were 6168 (55.1%) males and 5026 (44.9%) females. In the multi-level group, there were 5033 (50.4%) males and 4953 (49.6%) females. In both single/multi-level groups, females were more likely to be of older age, be functionally dependent, and have higher BMI and lower preoperative hematocrit level. Males were more likely to be Caucasian, smokers, have myelopathy, diabetes mellitus, hypertension and bleeding disorders. In both single/multi-level groups, except for the higher incidence of urinary tract infection (UTI) in females and myocardial infarction (MI) in males, there were no significant differences in morbidity and mortality between males and females.

Conclusions: Several differences in demographics and baseline health status exist between males and females undergoing ACDF. When attempting to control for comorbid conditions, we found that sex by itself is not an independent risk factor for higher perioperative morbidity or mortality in patients undergoing ACDF, except for the higher incidence of UTI in females and MI in males. These results are important findings for clinicians and spine surgeons while counseling patients undergoing this type of procedure.

Keywords: Anterior cervical discectomy and fusion (ACDF); Female; Male; Outcomes; Propensity score matching; Sex; Subgroup analysis.

MeSH terms

Aged
Cervical Vertebrae* / surgery
Cohort Studies
Diskectomy / adverse effects
Female
Humans
Male
Retrospective Studies
Spinal Fusion* / adverse effects
Treatment Outcome