• Ritesh Karsalia, Ryan S Gallagher, Austin J Borja, Emily Xu, Jianbo Na, Scott D McClintock, and Neil R Malhotra.
• Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
• World Neurosurg. 2024 Dec 20: 123586123586.

BackgroundWhile studies have examined the relationship between sex and outcomes after lumbar fusion surgery, few have strictly controlled for other patient-level variables. In this study, we use coarsened exact matching to determine the effect of patient-reported sex on spinal fusion outcomes.MethodsOutcomes across 4680 consecutive adult single-level, posterior-only lumbar fusions at a multihospital academic medical center were retrospectively assessed. First, univariate analyses were performed to broadly examine the effect of sex on surgical outcomes, uncontrolled for other patient factors. Next, the population was split by sex (male vs. female) and matched 1:1 on demographic and medical factors known to influence outcomes (including age, race, smoking status, and past surgical history) using coarsened exact matching (CEM). CEM effectively controls for confounding variable bias by creating pairs of matched samples and preserving the fidelity of each covariate through binning. Primary outcomes included 30- and 90-day readmissions, Emergency Department visits, reoperations, and mortality. Secondary outcomes included discharge disposition and length of hospital stay.ResultsBetween otherwise exactly matched male-female pairs, females were less likely to be discharged home (OR 1.70, p<0.001) and had a longer length of stay (mean: 95.7 vs 87 hr, p<0.001). No differences in readmissions or reoperations were observed between matched cohorts.ConclusionFemale patients encountered longer hospital stays and higher odds of non-home discharge after single-level lumbar fusion compared to otherwise exactly matched male patients.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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