Patient Perceptions After Elective, Outpatient Lumbar Spine Surgery: Do Patients Prefer Same Day Discharge or an Overnight Stay?

Abstract

Study design: Single-center, survey-based study.

Objective: This study aims to assess patient experiences in ambulatory lumbar spine surgery, with a focus on their expectations and preferences regarding discharge disposition, as well as the impact of discharge timing and alignment with patient preferences on satisfaction and early recovery outcomes.

Summary of background data: While the safety and efficacy of ambulatory spine surgery have been well established, patient perceptions and experiences with these accelerated recovery pathways remain underexplored.

Methods: A custom survey, designed by the authors, assessed patient experiences, preferences, and satisfaction related to discharge disposition. Respondents were asked to reflect on their surgical experience, focusing on their preferences for discharge timing and the reasons behind those preferences. The survey was administered to adult patients who underwent primary single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) or laminectomy (MI-Lami) and were discharged either on the same day of surgery (SDD) or after an overnight hospital stay (OVN). Patient preferences were qualitatively analyzed to identify recurring themes, while their postoperative night one experience was quantitatively scored across multiple domains, including sleep quality, comfort, hygiene management, and overall satisfaction. These data were then used to explore the relationship between discharge timing, and preference concordance.

Results: A total of 227 responses were collected, with 64 (28.2%) undergoing MI-TLIF and 163 (71.8%) undergoing MI-Lami. Of these, 116 (51.1%) were discharged on the same day (SDD) and 111 (48.9%) had an overnight stay (OVN). While 36% preferred SDD and 49.8% preferred OVN, 56.9% reported feeling ready for same-day discharge. Qualitative analysis revealed that SDD preferences were driven by comfort at home, better sleep, and avoiding hospital inconveniences. Conversely, OVN preferences emphasized medical support, pain control, and logistical ease. Patients discharged the same day reported better care, sleep, hygiene, and comfort (P<0.05 for all). Those discharged in concordance with their preferences reported significantly lower rates of feeling discharged prematurely (3.4% vs. 32.3%; P<0.001) and superior outcomes across multiple domains, including pain control, comfort, and reduced burden on families (P<0.05 for all).

Conclusions: SDD patients reported improved postoperative experiences, including sleep and satisfaction. Aligning discharge timing with patient preferences further enhanced outcomes, emphasizing the importance of patient-centered discharge planning in spine surgery.