Clinical outcomes and cost analysis of elective spine surgery in ambulatory surgery centers versus hospital outpatient departments: A systematic review and meta-analysis

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 ten 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.