Medical Student Duke University School of Medicine
Introduction: Patients undergoing spine surgery experience significant perioperative physical discomfort and psychological stress. These factors are associated with negative outcomes like persistent pain, prolonged hospital stays, and readmission. While social support systems have been shown improve outcomes in other surgical disciplines, their role within spine surgery is not well defined. We performed a systematic review and meta-analysis of the impact of social support (e.g. marital status, living environment, support programs) on clinical outcomes among adults undergoing non-traumatic/non-oncologic spine surgery.
Methods: We searched MEDLINE via PubMed, EMBASE via Elsevier, and Scopus via Elsevier from database inception through October 2023. Keywords and subject headings included adult spine surgery, prognosis, postoperative period, outcomes, and social support. Review stages were conducted independently by two reviewers. For predictor-outcome pairs with greater than four studies, we performed a meta-analysis using a generalized linear mixed model and random effects model.
Results: In summary, 982 full texts were screened, and 22 studies based on 11,702 patients met the inclusion criteria. Sample sizes ranged from 19 to 2,070 patients with a mean (SD) of 532 (561) patients. The mean age was 57 (12) years, and 52% of the patients were female. A total of 55% of the studies reported a significant positive association between social support and favorable postoperative outcomes (readmission rates, pain, mobility, length of stay, discharge disposition, emergency department visits, ability to work). In a meta-analysis of marital status versus length of stay (n=5 studies), married individuals were significantly more likely to experience a shorter length of stay than non-married patients (OR 1.96, 95% CI: 1.28-3.00, I^2=57%). Additionally, 66% of studies reported a significant relationship between living with others and favorable outcomes.
Conclusion : Social support plays a crucial role in the care of patients undergoing spine surgery, yet it remains an underutilized aspect of perioperative planning. This systematic review and meta-analysis found that patients with social support experience a shorter length of hospital stay, fewer readmissions, and increased likelihood of home discharge. By enhancing perioperative planning for patients with limited social support networks, providers may improve outcomes for patients undergoing spine surgery.