Biological sex differences in pain response and functional outcomes after orthopedic surgery procedures: a scoping review

Abstract

Background/Objective: Post-operative pain is frequently experienced by patients following orthopedic surgery procedures despite improved surgical technology and anesthesia techniques. The intensity of postoperative pain is multifactorial and biological sex is a key component of pain analysis. In this review article, the authors examine the impact of biological sex on post-operative pain scores and surgical outcomes following orthopedic surgery procedures. Methods: A keyword-based search of the National Library of Medicine and the National Center for Biotechnology Information was utilized for this review. Through our literature search we identified 56 articles related to the impact of sex on post-operative pain. These studies were then tabulated and analyzed in detail to provide data for this review article. Results: There are a variety of factors that influence surgical outcomes in orthopedics including age, comorbidities, and biological sex. The reviewed studies found that women report higher pain scores in the initial 6 wk post-operative period after total joint arthroplasty, upper extremity surgery, spine surgery, and general orthopedic surgery. Female sex was also associated with higher opioid consumption following surgery. In addition, men tend to have better surgical outcomes following total joint arthroplasty, upper extremity procedures, and spine surgery. Discussion/Conclusion: Biological differences including hormones, anatomy, and psychosocial factors influence post-operative pain differences between sexes. Little data is available on orthopedic surgery post-operative pain scores between the sexes and therefore further research is needed. Biological sex must be considered when evaluating patient wellness following orthopedic surgery procedures.