1583. Gender Differences in Use of Prolonged Non-Operative Therapies Prior to Index ACDF Surgery

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


Prior to anterior cervical discectomy and fusion (ACDF) surgery, a trial of non-operative treatments is traditionally utilized for pain management in patients with cervical stenosis. While cervical stenosis is equally likely to affect males and females, there is a paucity of data evaluating gender disparities in the prolonged utilization of conservative therapy prior to ACDF surgery. 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 ACDF surgery in patients with symptomatic cervical stenosis.


Medical records from patients with symptomatic cervical stenosis undergoing 1, 2, or 3-level index ACDF procedures between 2007 and 2016 were gathered from a large insurance database. Records were searchable by International Classification of diseases(ICD) diagnosis and procedure codes, Current Procedural Terminology(CPT) codes and generic drug codes. The utilization of MNTs within 5 years prior to index ACDF surgery was assessed. “Utilization” was characterized by cost billed to patients, prescriptions written, and number of units billed.


A total of 2,254 patients(female: 53.1%) underwent 1, 2, or 3-level ACDF surgery. There were a significantly greater percentage of female patients that utilized NSAIDs(p<0.0001), opioids(p=0.0019), muscle relaxants(p<0.0001), cervical epidural steroid injections(p=0.0428), and physical therapy/occupational therapy treatments(p<0.0001). The total direct cost associated with all MNT prior to index ACDF was $4,833,384, with females spending $2,687,753(55.6%). On average, $2,144.36 was spent per patient on non-operative treatments (males:$2,028.01/patient, females:$2,247.29/patient). Female patients utilized 59.5% of the narcotic units billed for over >5 years prior to index surgery despite comprising 53.1% of the cohort. When normalized by number of pills billed per patient utilizing therapy, female patients utilized more NSAIDs, opioids, and muscle relaxants than men.


The results suggest that there are gender differences in the utilization of MNT for symptomatic cervical stenosis prior to ACDF surgery.