Gender Differences in Reported Quality of Life Post Spinal Surgery: A Systematic Review and Meta-analysis

Introduction: Biological differences between genders may result in different surgical outcomes. The literature lacks consistent evidence concerning pain perception and postoperative recovery across genders. This inconsistency has led to improper management following surgery. Our meta-analysis seeks to investigate gender disparities in patient-reported outcomes (PROs) following spinal surgeries. We aimed to evaluate the differences in PROs of disability and overall quality of life after spine surgery.

Methods: We performed a comprehensive research on PubMed, Scopus, and Cochrane databases for relevant studies involving patients who filled out quality-of-life questionnaires following spinal surgeries. We evaluated the patients’ Oswestry Disability Index (ODI) and overall quality of life scores, using a 36-item Short Form survey (SF-36) Mental Component Summary (MCS), and SF-36 Physical Component Summary (PCS).

Results: Our analysis encompassed four studies, one case-control and three prospective cohort studies with 18,380 total patients. The random-effects model analysis of the four studies revealed no significant gender disparity for ODI (3.70, 95%CI=-2.09-9.49, p=0.21) post-spine surgery. Likewise, we conducted a secondary analysis of three studies, involving 16,101 patients, for SF-36 MCS and PCS. The analysis demonstrated that females have a significantly lower mental health-related quality of life compared to males (Mean difference=2.00, 95%CI=1.62-2.39, p< 0.01), however, their physical health-related quality of life doesn’t vary significantly from males (Mean difference=1.52, 95%CI=-0.17-3.21, p= 0.08). There was a low to moderate level of heterogeneity in the data.

Conclusion : After spine surgery, females fare worse on SF-36 MCS than males, but females also have SF-36 PCS and ODI comparable to men. This shows women can struggle mentally after surgery and incentivizes more research looking at adequately managing pain and reducing both mental and physical suffering in this population.