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)

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