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T1
Study Intervention Complication Total number
Males, number (%)
Females, number (%)
Total complications
Males–complications, number (%)
Females–complications, number (%)
Findings
Bazaz et al. (2002) [2]
Anterior cervical spine surgery
Dysphagia 221 115 (52.0*) 106 (48.0*)
37* 13 (35.1*) 24 (64.9*) Males at decreased risk for incidence of dysphagia at 6 months postoperatively (p = 0.023)
Cahill et al. (2009) [3]
Anterior cervical spinal fusion
All complications
27,067 13,022* (48.1*)
14,055* (51.9*)
1321* 711 (54.0) 610 (46.0) Females at decreased odds for all complications; OR, 0.78 (95% CI, 0.7–0.87)
Cahill et al. (2009) [3]
Posterior cervical spinal fusion
All complications
2869 1619*
(56.4*)1249*
(43.5*)286* 165 (58.0) 121 (42.0) No significant
difference in overall complication rate between sexes; OR, 0.94 (95% CI, 0.73–1.2)
Cahill et al. (2009) [3]
Thoracic spinal fusion
All complications
3257 1600* (49.1*)
1657* (50.9*)
561* 315 (56.0) 246 (44.0) Females at decreased odds for all complications; OR, 0.71 (95% CI, 0.59–0.85)
Cahill et al. (2009) [3]
Lumbar spinal fusion
All complications
36,807 15,931*
(43.3*)20,888* (56.8*)
2613* 1155 (44.0) 1458 (56.0) No significant difference in overall complication rate
Appendix 3. Summary of findings from 45 studies describing postoperative complications by sex
T2
between sexes; OR, 0.96 (95% CI, 0.87–1.04)
Chen et al. (2009) [4]
Spine surgery Surgical site infection
195* NR NR 27* NR NR No significant difference in surgical site infection rate between sexes; OR, 1.305 (95% CI, 0.605–2.816)
Cloyd et al. (2010) [5]
Multilevel spinal fusion surgery
Major complications
124 56 (45.2) 68*(54.8*) 25 NR NR Males at increased odds of major complications in multivariate analysis; OR, 4.56 (95% CI, 1.28–16.24)
Cloyd et al. (2010) [5]
Multilevel spinal fusion surgery
Reoperation 124 56 (45.2) 68*(54.8*) 26* NR NR No significant difference in reoperation rate between sexes; OR, 0.94 (95% CI, 0.41–2.17)
Cloyd et al. (2010) [5]
Multilevel spinal fusion surgery
All complications
124 56 (45.2) 68*(54.8*) NR NR NR No significant difference in overall complication rate between sexes; OR, 1.44 (95% CI, 0.71–2.94)
Danto et al. (2012) [6]
Cervical discectomy
Dysphagia 149 80 (53.0) 69 (46.0) 18 NR NR No significant difference in rate
T3
of dysphagia and dysphonia combined between sexes; OR, 1.3 (95% CI, 0.5–3.2)
Danto et al. (2012) [6]
Cervical discectomy
Dysphonia 149 80 (53.0) 69 (46.0) 8 NR NR No significant difference in rate of dysphagia and dysphonia combined between sexes; OR, 1.3 (95% CI, 0.5–3.2)
Deyo et al. (1992) [7]
Lumbar spine surgery
All complications
18,122 10610 (59.0)
7512 (41.0)
1649* 934*(56.6*) 721*(43.7*) No significant difference in total complication rate between sexes, but females at decreased risk of combined complications and prolonged hospitalization; RR, 0.87 (95% CI, 0.77–0.97)
Deyo et al. (2010) [8]
Lumbar spinal stenosis surgery
Cardio-pulmonary complications or stroke
32,152 14,909 (46.0*)
17,243 (54.0)
984 472 (48.0*) 512 (52.0*) No significant difference in cardiopulmonary complication or stroke rate between sexes (p
T4
> 0.05)Deyo et al. (2010) [8]
Lumbar spinal stenosis surgery
Wound complications
32,152 14,909 (46.0*)
17243 (54.0)
398 179 (45.0*) 219 (55.0*) No significant difference in wound complication rate between sexes(p > 0.05)
Fang et al. (2005) [9]
Spinal surgery Infection 120 50 (42.0*) 70 (58.0*) 43 21 (48.8*) 22 (51.2*) No significant difference in infection rate between sexes (p = 0.25); OR, 1.58 (95% CI, 0.73–3.4)
Fineberg et al. (2013) [16]
Cervical spine surgery
Aspiration 20,2694 99,320* (49.0*)
103,374* (51.0)
1080 598*(55.4) 482*(44.6) Males at increased odds of aspiration (p < 0.001); OR, 1.4 (95% CI, 1.2–1.6)
Fineberg et al. (2013) [11]
Lumbar spinal fusion
Gastrointestinal hemorrhage
220,522 NR NR 310 NR NR Males at increased odds of GI hemorrhage (p < 0.001); OR, 2.3 (95% CI, 1.7–3.0)
Fineberg et al. (2013) [14]
Lumbar spine surgery
Pulmonary embolism
577415 NR NR 1042 NR NR Males at increased odds of pulmonary embolism (p = 0.006); OR, 1.3 (95% CI, 1.1–
T5
1.5); study DVT data did not meet our inclusion criteria
Fineberg et al. (2013) [15]
Cervical spine surgery
Perioperative cardiac complication
214,900 105,360*
(49.0*)109,540* (51.0*)
857 479*(55.9*) 378*(44.1) Females at decreased risk for perioperative cardiac complications (p < 0.0005) in univariate analysis
Fineberg et al. (2013) [10]
Lumbar spine surgery
Perioperative cardiac complication
578,457 285,156* (49.0*)
293,301* (51.0*)
3848 1874*(48.7*) 1974*(51.3) Males at increased odds of perioperative cardiac complications (p < 0.0005); OR, 1.2 (95% CI, 1.1–1.3)
Fineberg et al. (2014) [12]
Anterior lumbar fusion
Postoperative ileus
19,762 8930*
(45.0*)10,832* (55.0*)
1481 813*(54.9*) 668*(45.1) Males at increased odds of postoperative ileus with this surgery (p < 0.001) and for all lumbar fusion surgeries combined (p < 0.001); OR, 1.9 (95% CI, 1.8–2.0)
Fineberg et al. Posterior Postoperative 18,2801 79,687* 103,114* 4749 2769*(58.3*) 1980*(41.7) Males at
T6
(2014) [12] lumbar fusion ileus (44.0*) (56.0*) increased odds of postoperative ileus with this surgery (p < 0.001) and for all lumbar fusion surgeries combined (p < 0.001); OR, 1.9 (95% CI, 1.8–2.0)
Fineberg et al. (2014) [12]
Anterior/ posterior lumbar fusion
Postoperative ileus
17,959 8251* (46.0*) 9708*
(54.0*)1511 817*(54.1*) 694*(45.9) Males at
increased odds of postoperative ileus with this surgery (p < 0.001) and for all lumbar fusion surgeries combined (p < 0.001); OR, 1.9 (95% CI, 1.8–2.0)
Fineberg et al. (2013) [13]
Lumbar spine surgery
Delirium 57,8457 285,758* (49.4*)
292,699* (50.6)
4857 2161*(44.5*) 2696*(55.5) No significant difference between sexes in postoperative delirium rate in multivariate analysis
Friedman et al. (2007) [17]
Laminectomy Surgical site infection
123* 80*(65.0*) 43*(35.0*) 41 24 (59.0) 17*(41.0*) No significant difference in surgical site
T7
infection rate between sexes (p = 0.29); OR, 0.66 (95% CI, 0.30–1.43)
Garg et al. (2010) [18]
Anterior lumbar fusion
Vascular injury
212 92*(43.4*) 120 (56.6) 13 10 (76.9*) 3 (23.1*) Females at decreased risk for vascular injury (p = 0.013)
Goz et al. (2014) [19]
Spinal fusion Venous thromboembolic events
710,154 331,926 (46.7*)
378,228 (53.3*)
3514* 1925*(54.8*) 1589*(45.2*) Females at decreased odds of VTE (p = 0.0465); OR, 0.78 (95% CI, 0.62–1)
Gruskay et al. (2014) [21]
ACDF Major complications
2164 1057 (49.1) 1107 (50.9) 71 46*(64.8*) 25*(35.2*) Males at increased odds of major complications in multivariate analysis (p = 0.040); OR, 1.756 (95% CI, 1.027–3.003)
Hoffmann et al. (2013) [22]
Posterolateral fusion with rhBMP-2 implant
Nonunion requiring reoperation
1158 468 (40.4) 690 (59.6) 41 24 (58.5) 17 (41.5) Males at increased odds for nonunion; OR, 2.08 (95% CI, 1.13–3.83)
Hoffmann et al. (2013) [22]
Posterolateral fusion with rhBMP-2
Seroma requiring reoperation
1158 468 (40.4) 690 (59.6) 32 12 (37.5) 20 (62.5) Statistical difference in seroma rate
T8
implant between sexes NR
Hoffmann et al. (2013) [22]
Posterolateral fusion with rhBMP-2 implant
Infection requiring reoperation
1158 468 (40.4) 690 (59.6) 26 6 (23.1) 20 (76.9) No significant difference in infection rate between sexes (p = 0.2198).
Horwitz and Curtin (1975) [23]
Laminectomy Wound infections (sepsis)
496 333*(67.0*) 163 (33.0) 16 15 (93.8*) 1 (6.3*) Females at decreased risk for wound infection (significance level not reported)
Javalkar et al. (2011) [24]
Lumbar spinal stenosis surgery
Reoperation 335 167 (49.9) 168 (50.1) 44 27 (61.4) 17 (38.6) No significant difference in reoperation rate between sexes; OR, 1.2 (95% CI, 0.586–2.635)
King et al. (2009) [26]
Degenerative cervical spine disease surgery
Reoperation 12,338 6693 (54.0) 5645 (46.0)
688 405 (59) 283 (41) Males at increased odds of reoperation (p = 0.038); OR, 1.17
Koutsoumbelis et al. (2011) [27]
Spine surgery Surgical site infection
252 109 (43.3*) 143 (56.7*) 84 29 (34.4) 55 (65.6) No significant difference in surgical site infection rate between sexes in multivariate analysis (p = 0.07); OR, 1.95
T9
(95% CI, 0.95–4.01)
Kurtz et al. (2012) [28]
Lumbar fusion
Infection 15,674 5524 (35.2) 10,150 (64.8)
1355* NR NR No significant difference in infection rate between sexes (p = 0.2198)
Lee et al. (2007) [29]
Anterior cervical spine surgery
Dysphagia 310 158 (51.0*) 152 (49.0*)
48* 17* (35.0*) 31* (65.0*) Females at increased risk for dysphagia 12 months postoperatively (p < 0.02); prevalence ratio = 1.91 (95% CI, 1.1–3.33)
Lee et al. (2012) [30]
Spine surgery Medical complications
1591 914 (57.0) 677 (43.0) 676 NR NR Females at decreased risk of pulmonary complications only in multivariate analysis (p = 0.024); RR, 0.65 (95% CI, 0.43–0.94)
Lykissas et al. (2014) [31]
Lateral lumbar interbody fusion
Postoperative anterior thigh/groin pain
451 179 (40.0*) 272 (60.0*)
241* 45* (19.0*) 196* (81.0*) Males at decreased odds of anterior thigh/groin pain immediately postoperatively (p = 0.007); OR,
T10
0.525 (95% CI, 0.329–0.838)
Lykissas et al. (2014) [31]
Lateral lumbar interbody fusion
Motor deficit 451 179 (40.0*) 272 (60.0*)
139* 38* (27.0*) 101* (73.0*) No significant difference in motor deficit rate between sexes immediately postoperatively (p = 0.913); OR, 0.974 (95% CI, 0.604–1.569)
Lykissas et al. (2014) [31]
Lateral lumbar interbody fusion
Sensory deficit
451 179 (40.0*) 272 (60.0*)
200* 59* (30.0*) 141* (70.0*) No significant difference in sensory deficit rate between sexes immediately postoperatively (p = 0.854); OR, 1.043 (95% CI, 0.665–1.635)
Marquez-Lara et al. (2014) [33]
Lumbar fusion
Cerebral vascular accidents
264,891 115,487* (43.6*)
149,404* (56.4*)
340 143* (42.1*) 197* (57.9) No significant difference in CVA rate between sexes (p = 0.569)
Nandyala et al. (2014) [35]
Spinal fusion Visual loss 541,485 252,339* (46.6*)
289,146* (53.4*)
105 56* (53.3*) 49* (46.7) No significant difference in visual loss rate between sexes (p = 0.23)
Nassr et al. (2012) [36]
Multilevel cervical
C5 palsy 630 338 (53.7*) 292 (46.3*)
42 29 (69.0*) 13 (31.0*) Females at decreased risk of
T11
decompression C5 palsy (p = 0.05)
Ogelsby et al. (2013) [37]
Cervical spine surgery
Deep vein thrombosis
273,396 NR NR NR NR NR Males at increased odds of DVT (p < 0.0005); OR, 1.5 (95% CI, 1.3–1.8)
Ogelsby et al. (2013) [37]
Cervical spine surgery
Pulmonary embolism
273,396 NR NR NR NR NR Males at increased odds of PE (p < 0.0005); OR, 1.8 (95% CI, 1.4–2.4)
Pugely et al. (2014) [39]
Lumbar spine surgery
30-day readmission
15,668 7964*(50.8*) 7704*(49.2*) 695 323*(46.5*) 372*(53.5) Statistical difference in 30-day readmission rate between sexes in multivariate analysis NR
Pull ter Gunne et al. (2009) [40]
Spinal surgery Clinical infection
3174 1273 (40.1) 1901 (59.9)
132 58 (43.9*) 74 (56.1*) No significant difference in clinical infection rate between sexes (p = 0.359)
Riley et al. (2005) [42]
ACDF Dysphagia 454 237* (52.2) 217*(47.8) 128 NR NR No significant difference in dysphagia rate between sexes (p = 0.915); OR, 1.02 (95% CI, 0.68–1.55)
T12
Scheer et al. (2013) [43]
Adult spinal deformity surgery
Reoperation 268† 38 (14.2*) 231 (86.2*)
46 8 (17.4*) 38 (82.6*) Statistical difference in reoperation rate between sexes NR
Schnee et al. (1997) [44]
Iliac crest harvest for anterior cervical fusion
Infection/ dehiscence
144 73 (50.7*) 71 (49.3*) 9* 1 (11.1*) 8 (88.9*) Males at decreased risk of infection/dehiscence (p < 0.00001)
Schoenfeld et al. (2011) [50]
Spinal surgery Major complications
3475 1871 (54.0) 1604 (46.0)
179 NR NR No significant difference in major complication rate between sexes (p = 0.5); OR, 1.11 (95% CI, 0.82–1.5)
Schoenfeld et al. (2011) [50]
Spinal surgery Minor complications
3475 1871 (54.0) 1604 (46.0)
128 NR NR Females at increased odds of minor complications (p = 0.025); OR, 1.54 (95% CI, 1.06–2.25)
Schoenfeld et al. (2011) [50]
Spinal surgery All complications
3475 1871 (54.0) 1604 (46.0)
263 NR NR No significant difference in total complication rate between sexes in multivariate analysis; in univariate
T13
analysis, OR, 1.32 (95% CI, 1.02–1.69)
Schoenfeld et al. (2013) [47]
Spinal surgery DVT/PE 27,684 14,221 (51.4)
13,463 (48.6)
283 NR NR Males at increased odds of PE only (p = 0.0119); OR, 1.65 (95% CI, 1.12–2.44)
Schoenfeld et al. (2013) [46]
Spinal fusion Major complications
5887 2782 (47.0) 3092 (53.0)
457 NR NR Statistical difference in major complication rate between sexes NR
Schoenfeld et al. (2013) [46]
Spinal fusion Minor complications
5887 2782 (47.0) 3092 (53.0)
270 NR NR Males at decreased odds of minor complications (p = 0.004); OR, 0.7 (95% CI, 0.5–0.9)
Schoenfeld et al. (2013) [46]
Spinal fusion All complications
5887 2782 (47.0) 3092 (53.0)
608 NR NR Statistical difference in total complication rate between sexes NR
Schwab et al. (2012) [51]
Spinal deformity surgery
Major perioperative complications
953 NR NR 80 18 (32.5*) 54 (67.5*) Statistical difference in major perioperative complication rate
T14
between sexes NR
Shen et al. (2009) [52]
Elective spinal fusion surgery
All complications
122,8475 NR NR 177,392* NR NR Males at decreased odds of all complications (p < 0.001); OR, 0.76 (95% CI, 0.75–0.78)
Singh et al. (2013) [53]
Anterior cervical fusion
Dysphagia 159,590 76,349* (47.8*)
83,241* (52.2*)
4027* 2069* (51.4*) 1958* (48.6*) Males at increased odds of dysphagia (p < 0.001); OR, 1.16 (95% CI, 1.07–1.25)
Wang et al. (2012) [57]
Elective cervical spinal surgery
30-day readmission
58,428 29,438* (50.4*)
28,990 (49.6)
4595 NR NR Males at increased odds of 30-day readmission (p < 0.001); OR, 1.30; (95% CI, 1.22–1.39)
Wang et al. (2012) [57]
Lumbar spine surgery
30-day readmission
284,640 123,276*
(43.3*)161,364 (56.7)
20,786 NR NR No significant difference in 30-day readmission rate between sexes (p = 0.514); OR, 1.01 (95% CI, 0.98–1.04)
Zheng et al. (2002) [59]
Posterior lumbar spine decompression,
Blood transfusion
112 53 (47.3) 59 (52.7) 70 26 (37.1) 44 (62.9) No significant difference in blood transfusion
T15
fusion, and segmental instrumentation
required between sexes (p = 0.48); OR, 1.57 (95% CI, 0.44–5.59)
*Calculated from information provided in the article; †as reported in the article; ACDF = anterior cervical decompression and fusion; rhBMP-2 = recombinant human bone morphogenetic protein-2; OR = odds ratio; CI = confidence interval; RR = risk ratio; NR = not reported; GI = gastrointestinal; DVT = deep vein thrombosis; VTE = venous thromboembolism; CVA = cerebrovascular accident; PE = pulmonary embolism.