T1
Study / Intervention / Complication / Total number / Males, number (%) / Females, number (%) / Total complications / Males–complications,number(%) / Females–complications,number(%) / FindingsBazaz 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) / Femalesat 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 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 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 (p0.05)
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
(p0.05)
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 (p0.001); 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 (p0.001); 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, 1.1–1.5);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 (p0.0005) 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 (p0.0005); 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) / Malesat increased odds of postoperative ileus with this surgery (p0.001) and for all lumbar fusion surgeries combined (p0.001); OR,1.9 (95% CI, 1.8–2.0)
Fineberg et al. (2014)[12] / Posterior lumbar fusion / Postoperative ileus / 18,2801 / 79,687* (44.0*) / 103,114* (56.0*) / 4749 / 2769*(58.3*) / 1980*(41.7) / Males at increased odds of postoperative ileus with this surgery (p0.001) and for all lumbar fusion surgeries combined (p0.001); 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 ofpostoperative ileus with this surgery (p0.001) and for all lumbar fusion surgeries combined (p0.001); 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 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 implant / Seroma requiring reoperation / 1158 / 468 (40.4) / 690 (59.6) / 32 / 12 (37.5) / 20 (62.5) / Statistical difference in seroma rate between sexesNR
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 (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 (p0.02); 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,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 decompression / C5 palsy / 630 / 338 (53.7*) / 292 (46.3*) / 42 / 29 (69.0*) / 13 (31.0*) / Females at decreased risk of 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 (p0.0005); 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 (p0.0005); 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 analysisNR
Pullter 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)
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 (p0.00001)
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 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 sexesNR
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 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 (p0.001); 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*) / Malesat increased odds of dysphagia (p0.001); 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 (p0.001); 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, fusion, and segmental instrumentation / Blood transfusion / 112 / 53 (47.3) / 59 (52.7) / 70 / 26 (37.1) / 44 (62.9) / No significant difference in blood transfusion 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.