Sex Disparities in Postoperative Outcomes Among Patients With Spine Tumors

Objectives: Sex-based differences in postoperative outcomes have been reported in nononcologic spine surgery, but their impact among patients undergoing surgery for spine tumors remains poorly understood. We conducted a systematic review to evaluate the impact of patient sex on postoperative length of stay (LOS) and nonroutine discharge (NRD). Methods: A systematic literature search was performed according to PRISMA guidelines. Independent reviewers screened studies for eligibility. Studies were included if they evaluated adult patients undergoing spine tumor surgery and reported postoperative LOS and/or NRD stratified by patient sex. Study quality was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence and the Methodological Index for Non-Randomized Studies (MINORS). Results: Twelve retrospective cohort studies comprising 250,648 patients met the inclusion criteria. All studies were classified as moderate quality based on MINORS criteria. Nine studies evaluated LOS, with 3 demonstrating significant associations with patient sex. Two studies reported higher odds of prolonged LOS among female patients, whereas one reported higher odds among male patients. Nine studies evaluated NRD of which 4 found significantly higher odds of NRD among female patients, while 5 found no association. Conclusions: Evidence regarding sex-based differences in postoperative LOS and NRD was mixed, although female sex was more consistently associated with prolonged hospitalization and nonroutine discharge. These findings suggest that sex-based disparities in postoperative resource utilization may exist in spine oncology and should be considered in perioperative risk stratification and discharge planning.