Sex Disparities in Outpatient Management of Postlaminectomy Syndrome

Abstract

Abstract INTRODUCTION Postlaminectomy syndrome (PLS), a major cause of chronic back pain following spinal surgery, is often managed with pharmacological (ie, opioid narcotics, NSAIDs, intraspinal injections) or surgical interventions (eg, spinal cord stimulation). Despite the burden of opioid-related overdose, abuse, and mortality especially in the setting of postprocedural analgesia, there exists a gap in current literature regarding sex differences in opioid prescriptions. This study investigates sex-related disparities in opioid prescriptions pertaining to PLS in a large national survey of ambulatory clinic visits. METHODS We extracted outpatient clinic visit data from the 2007 to 2016 National Ambulatory Medical Care Survey (NAMCS) (n = 126 males, n = 96 females) for patients who were seen for PLS. Variables collected included medications and potential covariates (age, race, insurance coverage, and medical history). Baseline patient characteristics were compared using Chi-square tests for nominal variables, and differences in means were compared using a two-tailed t-test (a = 0.05). RESULTS Males and females evaluated for PLS were similar at baseline with respect to age, race, medical history, and insurance except for Medicare coverage (26.19% of males vs 39.58% of females; P = .048). Despite similar baseline qualities, men had significantly higher rates of opioid prescription than women (76.19% vs 58.33%; 95% CI 1.07-1.59; P = .007). However, there were no differences in methadone maintenance therapy, NSAID, spinal cord stimulation, or intraspinal injection prescriptions. CONCLUSION Despite similar baseline characteristics, males with PLS were significantly more likely to be prescribed opioids compared to their female counterparts. This novel finding, which contrasts with established trends noting higher rates of opioid use in women, may result from physician bias or differing manifestations of PLS pain in men and women.