Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI.
Spine (Phila Pa 1976). 2024 Jul 1;49(13):E193-E199. doi: 10.1097/BRS.0000000000004999. Epub 2024 Apr 4.
Meta-analysis.
This meta-analysis aims to compare same-day versus staged spine surgery, assessing their effects on patient care and health care system efficiency.
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, health care 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.
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, operations, and nonhome discharge.
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 nonhome discharge between the 2 groups.
Both staged and same-day spinal fusion surgeries showed comparable rates of death, operations, and nonhome 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.
荟萃分析。
本荟萃分析旨在比较同一天与分期脊柱手术，评估它们对患者护理和医疗系统效率的影响。
在脊柱手术中，同一天和分期手术哪种更适合患者的争论仍在继续，因为这一决策可能会影响患者相关结局、医疗资源和总体成本。一些外科医生主张分期手术，认为可以降低并发症风险，而另一些外科医生则宣称同一天手术可以最大限度地降低成本和住院时间。
检索了 PubMed、Cochrane 和 Google Scholar（第 1-20 页），检索截至 2024 年 2 月。研究的结果是手术室（OR）时间、估计失血量（EBL）、住院时间（LOS）、总并发症、静脉血栓栓塞症（VTE）、死亡、手术次数和非家庭出院。
本荟萃分析纳入了 16 项回顾性研究，共纳入 2346 例患者，其中 644 例接受分期脊柱融合手术，1702 例接受同一天手术。分期组和同一天手术组的 EBL 无统计学差异。然而，分期组的 OR 时间（P=0.05）和 LOS（P=0.004）显著更长。总并发症（P=0.002）和 VTE（P=0.0008）的发生率与分期组显著相关。两组的死亡率、再次手术率和非家庭出院率无显著差异。
分期和同一天脊柱融合手术对接受脊柱手术的患者的死亡率、手术次数和非家庭出院率显示出相似的比率。然而，鉴于分期脊柱手术与 OR 时间延长、 LOS 延长和并发症增加相关，本研究支持在可能的情况下进行同一天手术，以减轻医疗资源负担并提高效率。
