Sex-related differences in pain following posterior spinal fusion for adolescent idiopathic scoliosis: a retrospective cohort study.

PURPOSE: While opioids are commonly prescribed for postoperative pain management, their use is recommended with caution in pediatric populations. In adult populations, patient sex has been identified as a predictor for increased opioid use, and understanding sex-related differences in postoperative pain is important for optimizing analgesia safety in adolescents undergoing posterior spinal fusion for idiopathic scoliosis. METHODS: A single-institution retrospective cohort study was conducted on patients < 18 years who underwent corrective surgery for adolescent idiopathic scoliosis (AIS). Variables included patient demographics and socioeconomic factors. Primary outcomes were patient-reported pain scores on a 0-10 scale during the index hospitalization. Secondary outcomes included total inpatient opioid consumption (converted to morphine milligram equivalents), discharge opioid prescriptions, and rates of opioid refills. RESULTS: In total, 266 patients were analyzed, including 188 (71%) females and 78 (29%) males. Female patients reported higher pain across multiple inpatient pain outcomes, including postoperative day 1 (least-squares [LS]-mean difference 0.97, 95% CI 0.41-1.50, p < 0.001), highest inpatient score (LS-mean difference 0.54, 95% CI 0.07-1.00, p = 0.025), and discharge pain score (LS-mean difference 1.10, 95% CI 0.38-1.90, p = 0.003). Descriptively, mean total opioid consumption was higher among males (37.8 ± 20.3 mg vs. 35.4 ± 17.7 mg in females); however, sex was not significantly associated with total opioid use in adjusted models. CONCLUSIONS: In our cohort of AIS patients undergoing posterior spinal fusion, female patients reported higher levels of pain during the early postoperative period. Clinicians should be aware of these differences to set appropriate expectations, provide guidance, and develop more personalized pain management strategies to ensure analgesia for all patients.

Duke Scholars

Author Cynthia Lea Green Biostatistics & Bioinformatics, Division of Biostatistics

Author Robert Lark Orthopaedic Surgery

Author Anthony Agostino Catanzano Jr. Orthopaedic Surgery