ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Sex difference in outcomes and risk factors for lumbar decompressive surgery.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeEvaluate the sex difference in perioperative patient-reported outcome measures (PROMs), 12-month PROM risk-factors, and 12-month PROM prediction models for lumbar decompressive surgery.
methodsThe study included 2938 cases. The primary 12-month PROM was Oswestry Disability Index (ODI), and secondary PROMs were back and leg pain. Other outcomes included 12-month EQ-5D, and 3-month opioid / non-opioid analgesic intake and employment. Twelve-month PROM predictive models were developed with 2008-2022 data and validated on 2023 data. Sex-specific PROM model predictive performance was compared to non-specific models (both sexes in model). Model calibration was by R
resultsAcross seven metrics, an absolute 4-15% more females than males had a poor outcome. The risk-factor effect on 12-month PROMs was equal for each sex; however, females have more PROM risk-factors. Females have higher prevalence of depression/anxiety, rheumatoid arthritis, osteoarthritis, mobility aided, extreme BMI, scoliosis, vertebral body fracture, and more severe and longer duration of preoperative symptoms linked to poorer PROM. In contrast, males have higher prevalence of diabetes and current smokers. Model validation found sex-specific 12-month ODI model predictive performance (R
conclusionCompared to males, females had poorer outcomes, more PROM risk-factors, and accelerated age-related thoracolumbar degenerative change. However, a similar proportion of each sex achieves improvement in each outcome metric after surgery. Sex-specific 12-month PROM models are not indicated.
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