Abstract
INTRODUCTION: This systematic review and meta‐analysis evaluates the impact of surgical timing after preoperative embolization on outcomes in spinal metastases by comparing early (<1 day) and late (>1 day) surgeries. METHODS: In January 2025, a systematic search of PubMed, Embase, and Cochrane yielded a total of 1,764 studies. Among these, seven retrospective studies, involving 357 patients, met the predefined inclusion criteria. Studies comparing early (<1 day) and late (>1 day) surgery after embolization were included. Exclusion criteria comprised non‐original studies, lack of separate timing groups, and indirect blood loss, such as changes in hemoglobin levels. The risk of bias was assessed using the ROBINS‐I tool, and data were analyzed with a random‐effects model implemented in R software. RESULTS: No significant differences were identified in intraoperative blood loss (IBL) (mean difference [MD] = ‐189.56 mL; 95% confidence interval [CI] ‐497.58 to 118.45; p = 0.23), estimated blood loss (EBL) (MD = 16.30 mL; 95% CI ‐85.90 to 118.49; p = 0.75), transfusion requirements (MD = ‐126.95 mL; 95% CI ‐359.08 to 105.18; p = 0.28), or operative time (MD = ‐14.34 minutes; 95% CI ‐30.03 to 1.34; p = 0.07). Furthermore, a subgroup analysis comparing degrees of embolization showed that early surgical intervention significantly reduced IBL in cases of complete embolization (MD = ‐596.23 mL; 95% CI ‐1028.62 to ‐163.84; p < 0.01). CONCLUSIONS: Early surgery following complete embolization of spinal metastases significantly reduces intraoperative blood loss. No statistically significant difference was observed between groups in other outcomes. [Image: see text] [Image: see text]