Comparative assessment of surgical outcomes and cost-efficiency between orthopedic surgeons and neurosurgeons in degenerative lumbar spine surgery: a systematic review with pairwise and proportional meta-analysis

Abstract

This study combines pairwise and proportional meta-analyses to evaluate differences in outcomes and cost-efficiency between neurosurgeons (NS) and orthopedic surgeons (OS) for lumbar degenerative disease. Following PRISMA guidelines, PubMed, ScienceDirect, Ovid, Web of Science, and Springer Link were searched for studies comparing NS and OS outcomes. Results for pairwise meta-analysis were generated with the "metabin" function using standardized mean differences (SMD) for continuous variables and odds ratios (OR) for binary variables, while the "metaprop" function was used to calculate pooled proportions in proportional meta-analysis. The study was registered in PROSPERO (CRD42024545992). Of the 457 search results, 7 studies were included. Compared to OS patients, NS patients exhibited significantly higher overall complication rates [OR: 1.09 (95% CI: 1.03-1.15); NS: 9.49%, OS: 8.92%], hospital costs [SMD: 0.30 (95% CI: 0.28-0.31); NS: $37,251.78, OS: $31,024.18], and hospital stays [SMD: 0.03 (95% CI: 0.01-0.04); NS: 3.32 days, OS: 3.23 days], while with no significant differences in superficial surgical site infections [OR: 1.12 (95% CI: 0.97, 1.31); NS: 1.70%, OS: 1.13%], deep surgical site infections [OR: 1.09 (95% CI: 0.99, 1.20); NS: 0.78%, OS: 0.67%], wound dehiscence [OR: 1.10 (95% CI: 0.98, 1.22); NS: 0.66%, OS: 0.57%], pneumonia [OR: 1.06 (95% CI: 0.92, 1.22); NS: 1.29%, OS: 1.13%], urinary tract infections [OR: 1.22 (95% CI: 1.07, 1.38); NS: 1.51%, OS: 1.31%], sepsis [OR: 1.25 (95% CI: 0.97, 1.61); NS: 0.80%, OS: 0.58%], or pulmonary embolism [OR: 1.13 (95% CI: 0.85, 1.51); NS: 0.41%, OS: 0.35%]. NS patients showed lower, though insignificant, rates of deep vein thrombosis [OR: 0.95; NS: 0.66%, OS: 0.57%], unplanned readmissions [OR: 1.00; NS: 4.64%, OS: 4.67%], and reoperations [OR: 0.91; NS: 3.94%, OS: 4.25%] compared to OS patients. Despite differing training backgrounds, NS and OS show comparable outcomes overall, with unique strengths suggesting that collaborative efforts may enhance lumbar surgery outcomes.

Keywords: Comparative effectiveness research; Cost-Efficiency; Lumbar Degenerative Disease; Neurosurgeon; Orthopedic Surgeon; Surgical Outcomes.