Clinical outcomes and cost analysis of elective spine surgery in ambulatory surgery centers versus hospital outpatient departments: A systematic review and meta-analysis.
5 affiliations
- 1Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria.
- 2Department of Neurosurgery, Queens Medical Centre, Nottingham, United Kingdom.
- 3Department of Neurosurgery, Surgery Interest Group Africa, Lagos, Nigeria.
- 4Department of Neurosurgery, The Royal London Hospital, London, United Kingdom.
- 5Department of Neurosurgery, Feinberg School of Medicine, Illinois, Chicago, United States.
Abstract
Background
The shift of elective spine surgery to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs) is driven by advances in minimally invasive techniques and cost-containment pressure. Comparisons between settings are confounded by patient selection bias, leaving true cost and safety differences unresolved.Methods
This systematic review and meta-analysis (Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020) compared clinical outcomes, operative efficiency, and costs of elective spine surgery in ASCs versus HOPDs across twelve observational studies (49,054 patients). Data were pooled using random-effects models; methodological quality was assessed with risk of bias in nonrandomized studies of interventions V2.Results
ASC patients were significantly younger and healthier. Clinical outcomes were equivalent across settings (reoperations relative risk [RR] 0.80; complications RR 0.88; 30-day readmissions RR 0.94). ASCs demonstrated superior operative efficiency (blood loss mean difference [MD] -20.24 mL, p = 0.01; operative time MD -15.05 min, p = 0.03) and 25-45% cost savings for single-level lumbar procedures.Conclusion
For younger, healthier patients undergoing single-level procedures, ASC spine surgery is as safe as HOPD surgery and offers superior efficiency and cost savings, provided rigorous patient selection is maintained.
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BibTeX
@article{daniel2026clinical,
title = {{Clinical outcomes and cost analysis of elective spine surgery in ambulatory surgery centers versus hospital outpatient departments: A systematic review and meta-analysis.}},
author = {Jeremiah Oluwatomi Itodo Daniel and Daniel Robinson and Kehinde Alare and Alex Mwangi Kihunyu and Chiamaka Bianca Offorbuike and Emmanuel Oyesiji and Raheem Olalekan Bello and Bunmi Adedotun and Olatomiwa Olukoya and Najib El Tecle},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_402_2026},
url = {https://europepmc.org/article/MED/42974329},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Clinical outcomes and cost analysis of elective spine surgery in ambulatory surgery centers versus hospital outpatient departments: A systematic review and meta-analysis.
AU - Jeremiah Oluwatomi Itodo Daniel
AU - Daniel Robinson
AU - Kehinde Alare
AU - Alex Mwangi Kihunyu
AU - Chiamaka Bianca Offorbuike
AU - Emmanuel Oyesiji
AU - Raheem Olalekan Bello
AU - Bunmi Adedotun
AU - Olatomiwa Olukoya
AU - Najib El Tecle
PY - 2026
DA - 2026/10/16
JO - Surgical neurology international
DO - 10.25259/sni_402_2026
UR - https://europepmc.org/article/MED/42974329
AB - Background The shift of elective spine surgery to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs) is driven by advances in minimally invasive techniques and cost-containment pressure. Comparisons between settings are confounded by patient selection bias, leaving true cost and safety differences unresolved.Methods This systematic review and meta-analysis (Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020) compared clinical outcomes, operative efficiency, and costs of elective spine surgery in ASCs versus HOPDs across twelve observational studies (49,054 patients). Data were pooled using random-effects models; methodological quality was assessed with risk of bias in nonrandomized studies of interventions V2.Results ASC patients were significantly younger and healthier. Clinical outcomes were equivalent across settings (reoperations relative risk [RR] 0.80; complications RR 0.88; 30-day readmissions RR 0.94). ASCs demonstrated superior operative efficiency (blood loss mean difference [MD] -20.24 mL, p = 0.01; operative time MD -15.05 min, p = 0.03) and 25-45% cost savings for single-level lumbar procedures.Conclusion For younger, healthier patients undergoing single-level procedures, ASC spine surgery is as safe as HOPD surgery and offers superior efficiency and cost savings, provided rigorous patient selection is maintained.
SN - 2229-5097
SN - 2152-7806
ER -