2Research fellow, doctor of medicine
3Neurosurgeon, doctor of medicine
Paper |
Year |
Study Sample Underwent |
Gender related result |
Herren et al.17 |
2014 |
Posterior lumbar spine fusion procedures |
Male gender was a factor prolonged LOS |
Schoenfeld et al.18 |
2013 |
Spine trauma |
Male gender was a predictor for higher mortality and higher complication rate |
Alosh et al.19 |
2015 |
Anterior cervical spine surgery |
Male gender was an independent predictor of hospital charges and LOS |
Kelly et al.20 |
2014 |
Surgical correction of spondylolisthesis |
Female gender was a factor prolonged LOS |
Yoshihara et al.21 |
2014 |
Surgical treatment of thoracic disc herniation |
Female gender was a risk factor for mortality |
Sharma et al.22 |
2014 |
Spinal cord tumor surgeries |
Female gender was an independent predictor of adverse discharge disposition but not to higher costs |
Wait et al.23 |
2013 |
Cervical or Lumbar spinal fusions |
Gender did not show any impact on LOS |
A history of coronary artery disease was the only variable that showed more prevalence in the male cohort (P=0.041). However, variables that were more prevalent in the female cohort were postoperative anemia severity (P<0.001), vitamin D deficiency (P=0.014), diabetes mellitus (P=.05), hypothyroidism (P=0.005), anxiety disorders (P=0.002), major depressive disorder (P=0.001), obesity (BMI>30, P=0.013), hypotension (P=0.029), severe postoperative respiratory problems (P=0.055), and postoperative psychiatric symptoms (P=0.045).
Variables that showed a significant impact on LOS in the male cohort were postoperative anemia (P=0.033), number of operated levels (P=0.053), developing postoperative infections (P=0.012), postoperative pulmonary embolism (P=0.008), and
|
All patients |
Males |
Females |
Preoperative Anemia (Y/N) |
30.0% |
30.2% |
29.4% |
Myocardial Infarction |
3.7% |
4.3% |
3.2% |
Coronary Artery Disease (other than MI) |
11.0% |
15.0% |
7.9% |
Congestive Heart Failure |
1.5% |
1.4% |
1.6% |
Arrhythmias |
4.8% |
5.7% |
4.2% |
Hypertension |
66.1% |
63.6% |
67.9% |
Respiratory Disorders (other than sleep related) |
26.2% |
23.0% |
28.6% |
Chronic Obstructive Pulmonary Disease |
11.6% |
12.2% |
11.1% |
Sleep Apnea |
10.4% |
12.9% |
8.5% |
Chronic Constipation |
14.2% |
12.9% |
15.3% |
Peptic Ulcer Disease |
2.7% |
2.1% |
3.2% |
Renal Failure |
2.1% |
1.4% |
2.6% |
Diabetes Mellitus |
30.0% |
24.3% |
34.2% |
Hypothyroidism |
18.6% |
11.5% |
23.8% |
Stroke |
5.5% |
4.3% |
6.3% |
Transient Ischemic Attach |
1.8% |
0.7% |
2.6% |
Seizure |
2.1% |
0.7% |
3.2% |
Neuromuscular Disorders |
1.8% |
1.4% |
2.1% |
Memory Loss |
5.5% |
3.6% |
6.8% |
Anxiety Disorders |
20% |
12.1% |
25.8% |
Major Depression |
26.1% |
16.4% |
33.2% |
Arthritis |
58.8% |
61.4% |
56.8% |
Obesity (BMI≥30) |
57.1% |
49.3% |
63.0% |
Morbid Obesity (BMI≥40) |
10.6% |
10.0% |
11.1% |
Total Comorbidities |
5.8 |
5.4 |
6.1 |
|
|
All patients |
Males |
Females |
Postoperative Anemia Severity |
No anemia (≥12 in f. / ≥13.5 in m.) |
4.6% |
5% |
4.3% |
Mild Anemia (<12 in f. / <13.5 in m. to ≥10) |
32.3% |
51.8% |
17.7% |
|
Moderate (<10 to ≥8) |
39.1% |
32.4% |
44.1% |
|
Severe (<8) |
24% |
10.8% |
33.9% |
|
Dural Tear/CSF Leak |
|
3.4% |
1.4% |
4.7% |
Fever |
|
24.7% |
20.3% |
22.6% |
Infections (total) |
|
12.2% |
9.4% |
14.2% |
Urinary Tract Infection |
|
3.7% |
2.2% |
4.7% |
Wound Infection |
|
2.4% |
2.2% |
2.6% |
Respiratory Complaints |
|
7.0% |
5.8% |
7.9% |
Pulmonary Embolism |
|
1.2% |
2.2% |
0.5% |
Urinary Retention |
|
2.4% |
1.4% |
3.2% |
Postoperative Psychiatric Symptoms (e.g. hallucination, delirium) |
|
3.0% |
0.7% |
4.7% |
Constipation |
|
12.5% |
9.4% |
14.7% |
Total Number of Complication |
|
2.2 |
2.1 |
2.2 |
Another variable that should be discussed is rehabilitation status. Ireland, Kelly, and Cumming (2015) stated that "referral to hospital-based rehabilitation effectively doubles the total LOS," suggesting that anyone who is subject to rehabilitation after their acute hospital stay will have a longer LOS. This suggests that a patient's post-operative rehabilitation status should be taken into account when determining their LOS. It may be that patients
|
|
All patients |
Males |
Females |
Length of Hospital Stay (Days) |
|
5.3 |
4.7±3.7 |
5.7±3.1 |
Gender |
|
|
140 (42%) |
190 (57%) |
Age |
|
58.0 |
56.1 ±13 |
58.6 ±9.7 |
>60 years old |
48.8% |
46.4% |
50.5% |
|
Race |
Caucasians |
|
76.4% |
64.2% |
African American |
|
20.7% |
34.7% |
|
Type of Insurance |
Medicare |
|
56.4% |
55.8% |
Medicaid |
|
5.7% |
7.9% |
|
Private Insurance |
|
26.4% |
24.7% |
|
Uninsured |
|
5.0% |
4.7% |
|
Other |
|
5.0% |
6.8% |
|
Number of Operated Levels |
1 |
|
47.1% |
42.1% |
2 |
|
27.1% |
32.6% |
|
3 |
|
16.4% |
15.8% |
|
>3 |
|
9.3% |
9.5% |
|
Body Mass Index (BMI in kg/m2) |
|
31.1 |
30.3 |
31.6 |
Anti-Platelet use |
|
26.4% |
28.3% |
25.0% |
Drain insertion |
|
64.3% |
66.7% |
62.6% |
Cell Saver Use |
|
72.9% |
68.8% |
75.8% |
The Need for Blood Transfusion |
|
10.5% |
7.3% |
12.8% |
Preoperative Hemoglobin Level |
|
13.4 |
14.3 |
12.7 |
Postoperative Hemoglobin Level |
|
9.5 |
10.3 |
8.9 |
Vitamin D (ng/mL) |
|
27.3 |
28.9 |
26.3 |
Vitamin D < 20 |
29.1% |
19.5% |
35.5% |
In our study cohort females were afflicted with more comorbidites than were males possibly referable to the differing hormonal profile of females that could provide further insight as to why female's have a longer LOS than men. Studies consistently mentioned that estrogen modulates pain sensation via its α and β receptors that spread throughout the central and peripheral nervous systems (Alstergren, Ernberg, Kvarnström, Kopp, 1998; Nomura, et al., 2005; McEwen and Alves, 1999), including the dorsal root ganglia (Papka, et al., 2001), as well as throughout inflammatory cells like monocytes (Phiel, Henderson, Adelman, Elloso, Lett, 2005). The study performed by Craft et al. implicated that estrogen was a stimulant of nociceptive afferents in the peripheral nervous system via different mechanisms (Craft, 2007). Female's inclination to have a higher sensitivity to pain, and their increased tendency to psychiatric distress both could contribute to their elongated LOS.
We suggest additional inquiry into the impact of comorbidities and complications with particular reference as to why certain comorbidities and complications contribute to prolonging female LOS and not male.
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