Same-Day Versus Staged Spinal Fusion: A Meta-analysis of Clinical Outcomes

Abstract

Study Design: Meta-Analysis Objective: This meta-analysis aims to compare same-day versus staged spine surgery, assessing their effects on patient care and healthcare system efficiency. Background: In spinal surgery, the debate between whether same-day and staged surgeries are better for patients continues, as the decision may impact patient related outcomes, healthcare resources and overall costs. While some surgeons advocate for staged surgeries citing reduced risks of complications, others proclaim same-day surgeries may minimize costs and length of hospital stays. Methods: PubMed, Cochrane and Google Scholar (Pages 1-20) were searched up until February 2024. The studied outcomes were operative room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), overall complications, venous thromboembolism (VTE), death, reoperations and non-home discharge. Results: Sixteen retrospective studies were included in this meta-analysis, representing a total of 2346 patients of which 644 underwent staged spinal fusion surgeries and 1702 same-day surgeries. No statistically significant difference was observed in EBL between staged and same-day surgery groups. However, the staged group exhibited a statistically significant longer OR time (P= 0.05) and LOS (P=0.004). A higher rate of overall complications (P=0.002) and VTE (P=0.0008) was significantly associated with the staged group. No significant differences were found in the rates of death, reoperations, and non-home discharge between the two groups. Conclusion: Both staged and same-day spinal fusion surgeries showed comparable rates of death, reoperations and non-home discharges for patients undergoing spinal surgeries. However, given the increased OR time, LOS and complications associated with staged spinal surgeries, this study supports same-day surgeries when possible to minimize the burden on healthcare resources and enhance efficiency.