Gender differences in the 3-month utilization of nonoperative therapies prior to primary lumbar microdiscectomy. (June 2020)

• Record Type: Journal Article
• Authors: Davison, Mark A.; Lilly, Daniel T.; Moreno, Jessica; Bagley, Carlos; Adogwa, Owoicho
• Is Part Of: Journal of clinical neuroscience. Volume 76(2020)
• Page Start: 107
• Page End: 113
• Publication Date: 2020-06
• Subjects: Lumbar intervertebral disc herniation -- Healthcare utilization -- Nonoperative therapy -- Microdiscectomy -- Lumbar spine surgery -- Gender differences; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.04.033
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: This was a retrospective study of 13, 106 patients who underwent microdiscectomy. Males were significantly more likely to fail conservative management than females. Females utilized more muscle relaxants and lumbar epidural steroid injections. The total direct cost associated with all nonoperative therapies was $13, 205, 924. Abstract: Patients with lumbar intervertebral disc herniation classically trial a brief course of conservative management prior to microdiscectomy surgery. Gender differences have previously been identified in the selection and symptomatic response to commonly-utilized nonoperative treatments. However, whether gender differences exist in the degree and cost of nonoperative therapy in this cohort remains unknown. Therefore, the purpose of this study was to assess for gender differences in the utilization and costs of nonoperative therapy in patients diagnosed with symptomatic lumbar intervertebral disc herniation 3-months prior to undergoing microdiscectomy. Medical records from adult patients diagnosed with a lumbar intervertebral disc herniation undergoing index microdiscectomy procedures from 2007 to 2017 were collected retrospectively from a large insurance database. The utilization of nonoperative therapy within 3-months after initial lumbar herniation diagnosis was determined. A total of 13, 106 patients (55.4% Males) underwent index microdiscectomy. Male patients were more likely to fail conservative management and opt for surgery (Males: 2.9% vs. Females: 1.8%, p < 0.0001). A greater percentage of female patients utilized muscle relaxants (p = 0.0049), lumbar epidural steroid injections (p = 0.0007), and emergency department services (p = 0.001). The total direct cost of conservative treatment prior to microdiscectomy was $13, 205, 924, with males accountable for $7, 457, 023 (56.5%). When normalized by number of patients utilizing the respective therapy, males used fewer units of NSAIDs (males: 84.2 pills/patient; females: 97.3 pills/patient) and muscle relaxants (males: 77.5 pills/patient; females: 89.0 pills/patient). These results suggest that gender differences exist in the utilization of nonoperative therapies for the management of a lumbar intervertebral herniated disc prior to microdiscectomy surgery.