1584. Gender Differences in Use of Prolonged Non-Operative Therapies Prior to Index Lumbar Surgery

Authors: Owoicho Adogwa, MD, MPH; Mark Davison, BS; Victoria Vuong; Daniel Lilly, BA; Shyam Desai, BA; Jessica Moreno; Joseph Cheng; Carlos Bagley (St Louis, MO)

Introduction: An assortment of non-operative therapies are traditionally attempted for pain management in patients with lumbar stenosis or spondylolisthesis prior to spinal fusion surgery. Women are equally likely to be affected by these diagnoses as men; however, there is a paucity of data assessing gender differences in prolonged utilization of pre-operative conservative therapy. The purpose of this study is to assess for gender-based differences in the utilization and cost of maximal non-operative therapy (MNT) prior to spinal fusion surgery in patients with symptomatic lumbar stenosis or spondylolisthesis. Methods: A large insurance database was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index lumbar decompression and fusion procedures between 2007 and 2016. This database consists of 20.9 million covered lives and includes private/commercially insured and Medicare Advantage beneficiaries. Only patients continuously active within the insurance system for at least 5 years prior to the index operation were eligible. Results: A total of 4,133 patients (female: 58.5%) underwent 1, 2, or 3-level posterior lumbar instrumented fusion. There was a significantly greater percentage of female patients that utilized NSAIDs (p <0.0001), LESI (p = 0.0044), PT/OT (p<0.0001), and muscle relaxants (p<0.0001). The total direct cost associated with all MNT prior to index spinal fusion was $9,000,968, with males spending $3,451,479 and females spending $5,549,489. When considering the quantity of units billed, females utilized 61.5% of the medical therapy units disbursed despite comprising 58.5% of the cohort. When normalized by number of pills billed per patient utilizing therapy, female patients utilized more NSAIDs, opioids, and muscle relaxants compared to male patients. Conclusion: The results suggest that there are gender differences in the utilization of non-operative therapies for symptomatic lumbar stenosis or spondylolisthesis prior to fusion surgery. Future studies are needed to corroborate our findings