The Impact of Social Support on Outcomes in Spine Surgery Patients

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To perform a systematic review and meta-analysis of the impact of social support on outcomes among adults undergoing nontraumatic/nononcologic spine surgery. SUMMARY OF BACKGROUND DATA: Spine surgery patients experience perioperative physical discomfort and psychological stress linked to negative outcomes like persistent pain, prolonged hospital stays, and re-admission. While social support is known to improve postoperative outcomes, its role within spine surgery remains unclear. METHODS: A systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (PubMed), EMBASE (Elsevier), and Scopus (Elsevier) were searched from inception through October 2023. Keywords included adult spine surgery, prognosis, postoperative period, outcomes, and social support. The risk of bias was assessed using the Newcastle-Ottawa Scale. Data regarding social support and outcomes were collected. A meta-analysis was conducted to evaluate the association between social support and postoperative outcomes. RESULTS: In summary, 982 full-text articles were screened, and 22 studies (11,702 patients) met the inclusion criteria. Samples ranged from 19-2070 patients (mean±SD: 532±562). The mean age was 55 years, and 52% were female. Half of the studies reported a significant positive association (P<0.05) between social support (eg, marital status, living environment, and support programs) and a favorable postoperative outcome [readmission rates, pain, mobility, length of stay (LOS), discharge disposition, emergency department visits, and ability to work]. In a meta-analysis (n=5 studies), married individuals had nearly twice the odds of a shorter LOS than nonmarried patients (OR=1.96, 95% CI: 1.28-3.00, I2=57%). CONCLUSIONS: Social support is a key predictor of clinical outcomes for spine surgery patients. While the types of social support reported in the literature were highly heterogeneous, patients with social support experienced shorter hospital stays, fewer readmissions, and increased home discharges. Enhancing perioperative resources for patients with limited social support networks may improve outcomes and enhance recovery for spine surgery patients. LEVEL OF EVIDENCE: Level II.