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Introduction: Lumbar decompression (LD) surgery, with or without discectomy, is a commonly performed surgical procedure. Despite the concept of day-case LD being reported as early as the 1980s, day-case LD is yet to become routine clinical practice., Research Question: This systematic review aimed to examine the published literature on the safety and complication rates of day-case LD. Secondary outcome measures, including the economic impact and patient satisfaction of day-case LD, were also examined., Materials and Methods: A systematic electronic search was carried out on PubMed, EMBASE and the Cochrane Library between 1999 and January 2022. Studies were screened against predefined inclusion/exclusion criteria with the quality of included studies subsequently being assessed., Results: In total, 15 studies were included in this review. The majority of studies were undertaken in the USA (n ​= ​8, 53%) and were of a case series design (n ​= ​9, 60%). Reported complication rates ranged from 0% to 7.8%, with nine studies reporting a complication rate of <4%. Readmission rates ranged from 0% to 7.7%. Seven studies quoted a readmission rate of 0%. Five studies found cost saving benefits of day-case LD in comparison to inpatient LD of up to $27,984 (USD). Patient acceptability of day-case LD was consistently high across the six studies that assessed it., Discussion and Conclusion: Day-case LD surgery is a safe and economically efficient surgical option in appropriately selected patients., Competing Interests: None of the authors declare any conflicts of interest. No financial funding was received for this study., (© 2022 The Authors.)