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Clinical Orthopaedics and Related Research®

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01-08-2015 | Symposium: Sex Differences in Musculoskeletal Disease and Science

Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review

Authors: Andrew J. Schoenfeld, MD, MSc, Elyse N. Reamer, BS, Emily I. Wynkoop, BS, Hwajung Choi, PhD, Christopher M. Bono, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 8/2015

Abstract

Background

Available studies disagree regarding the influence of patient sex on mortality and complications after spine surgery. We sought to conduct a systematic review and pool the results of existing research to better understand this issue.

Questions/purposes

We performed a systematic review to address two questions: (1) Does sex (male versus female) influence mortality after spine surgery? (2) Does sex impact the development of postoperative complications after spine surgery?

Methods

This systematic review was performed through a query of PubMed using a structured search algorithm. Additional queries of Embase, SCOPUS, Web of Science, and the tables of contents of orthopaedic and neurosurgical journals were also conducted using search terms such as “sex factors”, “male or female”, “risk factors”, and “spine surgery”. Selected papers were independently abstracted by three of the authors (AJS, ENR, EIW) and pooling was performed. Our literature search returned 720 studies, of which 99 underwent full review. Of these, 50 were selected for final abstraction. The Cochrane Q test was used to assess study heterogeneity; significant study heterogeneity was present and so a random-effects model was used. A Harbord test was used to evaluate for the presence of publication bias; this analysis found no statistically significant evidence of publication bias.

Results

Males were at increased odds of mortality after spine surgery (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.35–1.97; p < 0.001). No differences between the sexes were identified for the odds of complications (OR, 1.04; 95% CI, 0.95–1.13; p = 0.42).

Conclusions

Our results determined that males were at elevated odds of mortality but not of complications after spine surgery. These results should be used to inform preoperative discussion and decision-making at the time of surgical consent. Future work should be directed at determining the underlying factors responsible for increased mortality among males and prospective studies specifically designed to evaluate sex-based differences in outcomes after spine surgery.

Level of Evidence

Level III, therapeutic study.

Available only for authorised users

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Title: Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review
Authors: Andrew J. Schoenfeld, MD, MSc
Elyse N. Reamer, BS
Emily I. Wynkoop, BS
Hwajung Choi, PhD
Christopher M. Bono, MD
Publication date: 01-08-2015
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 8/2015
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-014-4102-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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