Sex Differences in Postoperative Complications and Functional Status After Deformity Correction Surgery: Do Men Fare Better Than Women?

Objective: We investigated whether a sex-related difference exists in the postoperative complication risk and health-related quality of life measures after surgery for adult spinal deformity.

Methods: We performed a retrospective study of 156 adult patients with a diagnosis of adult spinal deformity who had undergone spinal surgery. The primary outcome variables included the postoperative complication rates and changes in the health-related quality of life measures. Adjusted odds ratios were estimated by multivariate logistic regression with the inclusion of covariate terms for sex, smoking, preoperative optimization, American Society of Anesthesiologists grade, depression, osteoporosis, invasiveness of surgery (number of vertebral levels fused), and baseline functional disability.

Results: At presentation, the women were more likely to be smokers (74 women [71.15%]; 23 men [42.31%]; P = 0.01) and to have a greater prevalence of depression (36 women [34.62%]; 10 men [19.23%]; P = 0.06). The women had also presented with more severe baseline pain (visual analog scale for back pain score, 7.24 vs. 6.00 [P = 0.02]; visual analog scale for leg pain score, 5.87 vs. 5.59 [P = 0.07]) and worse functional disability (patient-reported outcomes measurement information system score, 6.82 vs. 5.65 [P = 0.01]; Oswestry disability index, 45.42 vs. 37.07 [P = 0.01]). However, postoperatively, the women experienced greater improvement in pain and disability compared with the men. The unadjusted odds of a postoperative complication was greater for the women (odds ratio, 1.14; 95% confidence interval, 0.55-2.33). On multivariate logistic regression analysis, the association between sex and postoperative complications was attenuated after controlling for other baseline variables.

Conclusions: In the present study, after adjustment for important baseline prognostic factors, no differences were found in the postoperative complication rates or extent of functional improvement when stratified by sex. Both sexes responded equally well to corrective surgery for symptomatic adult spinal deformity.