Elderly Women Report Worse Outcomes than Men Following Lumbar Discectomy, but Similar Satisfaction Rate

Harel Deutsch, MD Comments

While elderly women report poorer outcomes from lumbar disc herniation surgery, they are as satisfied with their outcome as elderly men are, according to findings from a large Swedish study reported in the European Spine Journal.
Senior couple using laptop in bedroomWhile elderly women report poorer outcomes from lumbar disc herniation surgery, they are as satisfied with their outcome as elderly men are.Researchers used the SweSpine, the national Swedish register for spine surgery, to identify 1,250 patients aged ≥65 years that underwent open discectomy for treatment of lumbar disc herniation between 2000 and 2012 and had 1-year postoperative data available.

Elderly women had a worse preoperative status than elderly men, with more severe and longer duration of back and leg pain, greater use of analgesics, inferior walking ability, inferior quality of life, and greater disability among women (all P<0.05). Similar gender discrepancy has been found among younger adults undergoing discectomy, the investigators noted.

Gender Differences in Outcome Among Surgical Cohort
Both elderly men and women showed marked improvement in pain, walking distance, and all patient reported outcome measures (PROMs) except for the general health subscale of the Short-Form 36 at 1-year postsurgery, with no significant difference in the degree of improvement by gender.

However, because elderly women had a poorer status preoperatively, their postoperative status at 1 year remained worse than in men, despite having a similar degree of improvement. Thus, postoperatively, female subjects had greater back and leg pain, greater analgesic use, inferior walking distance, poorer quality of life, and more pronounced disability than male subjects. In addition, while both genders showed inferior PROMs compared to age- and gender-matched normative data, women in the surgical cohort showed higher deficits than men.

Nevertheless, the satisfaction rate with surgical outcome was similar among elderly women and men (71% and 76%, respectively). “The reason is unclear but one explanation may be that the degree of improvement is more important for the subjective rating than the actual absolute end result values,” the study authors reported.

There is no evidence in the literature to support the poorer postoperative status among elderly women following discectomy, the investigators concluded, adding that future studies are needed to explore possible causes of this outcome.

Commentary
Harel Deutsch, MD
Associate Professor of Neurosurgery
Rush University Medical Center, Chicago, IL

This article analyzes the Swedish registry for spine surgery and looks at over 1,000 elderly patients (age >65 years) who had a lumbar discectomy. The article concludes that men improved more with surgery than women.

This is an interesting article, but one has to be careful about drawing any conclusions from small statistical variations. While some of the results were statistically significant, it is clear the magnitude of the difference is very small. The results look at patients’ subjective reports on questionnaires, and there may be gender-specific responses to questionnaires that may result in different scores despite the same surgery and clinical outcome.

Overall, as noted in the study, men and woman had similar satisfaction with the surgeries. While the article is interesting and establishes the effectiveness of lumbar discectomies in the elderly population, I don’t believe there are any clinical implications to the gender differences reported in the article.

Updated on: 02/08/18
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