Women have worse preoperative pain than men, but similar surgical satisfaction

While women may report worse preoperative neck pain than men, a new study reveals that they nonetheless report similar global outcomes and comparable satisfaction with cervical spine surgery to men.

To study the impact of gender on baseline and follow-up scores and the global outcome of cervical spine surgery, Dieter Grob, MD, and colleagues collected data on patients entered into Spine Tango, an international spine surgery registry. Preoperatively and at 12-month follow-up, the investigators asked patients to complete the Core Outcome Measures Index (COMI), an outcome tool which contains one question for each of the following domains:

function;
quality of life;
work and/or social disability;
neck pain intensity;
arm/shoulder pain intensity; and
symptom-specific well-being.

They also asked respondents to rate the global result of their surgery and satisfaction with treatment at 12-months postoperative.

Outcomes scores

The data of nearly 400 patients revealed that women scored worse than men on all seven domains of the COMI preoperatively and significantly lower for the higher neck.

The investigators discovered no significant differences between the groups regarding changes in most of the COMI domain scores from baseline to 12-month follow-up, but there were significantly greater improvements in neck pain for women when compared with men. In addition, they found similar global outcome and satisfaction with treatment in women and men.

"At baseline, women declared considerably worse neck pain than men and generally lower function and quality of life, which may mean they have a higher threshold for surgery," Grob said during his presentation at Spine Week 2008. "However, the change [in] follow-up scores for these domains and the global outcome/satisfaction with surgery were comparable between the sexes.

"Hence, although women declare more pain for a given preoperative condition, their responsiveness and satisfaction with treatment is just as good as that of men," he said.

Follow-up participation

All German-speaking patients undergoing cervical spine surgery in Grob's Spine Center participated in the study. The rate of follow-up at 12 months was 94%. The patients included 207 women and 191 men with a mean age of almost 60 years.

"The minority had previous surgery and almost half had a mono-segmental pathology," Grob said.

Twelve months after surgery, 77% of men and 77% of women reported a good global outcome score and 88% of men and 84% of women said that they were satisfied with their treatment.

For more information:
Dieter Grob, MD, can be reached at the Spine Center, Schulthess Klinik, Lengghalde 2 CH-8008, Zurich, Switzerland; +41-1-385-7436; e-mail: dieter.grob@kws.ch.

Reference:
Grob D, Porchet F, Dvorak J, et al. Influence of gender on baseline symptoms and outcome after cervical spinal surgery. Paper #C45. Presented at Spine Week 2008. May 26-31, 2008. Geneva.