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. 2020 Nov 27:13:122-126.
doi: 10.1016/j.jcot.2020.11.017. eCollection 2021 Feb.

Comparative outcome analysis of spinal anesthesia versus general anesthesia in lumbar fusion surgery

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Comparative outcome analysis of spinal anesthesia versus general anesthesia in lumbar fusion surgery

Richard Sekerak et al. J Clin Orthop Trauma. .

Abstract

Introduction: Spinal anesthesia (SA) has been shown in several studies to be a viable alternative to general anesthesia (GA) in laminectomies, discectomies, and microdiscectomies. However, the use of SA in spinal fusion surgery has been very scarcely documented in the current literature. Here we present a comparison of SA to GA in lumbar fusion surgery in terms of perioperative outcomes and cost.

Methods: The authors retrospectively reviewed the charts of all patients who underwent 1- or 2-level minimally invasive transforaminal lumbar interbody fusion (TLIF) surgery by a single surgeon, at a single institution, from 2015 to 2018. Data collected included demographics, operative and recovery times, nausea/vomiting, postoperative pain, and opioid requirement. Costs were included in the analysis if they were: 1) non-fixed; 2) incurred in the operating room (OR); and 3) directly related to patient care. All cost data represents net costs and was obtained from the hospital revenue cycle team. Patients were grouped for statistical analysis based on anesthetic modality.

Results: A total of 29 patients received SA and 46 received GA. Both groups were similar in terms of age, gender, BMI, number of levels operated upon, preoperative diagnosis, and medical comorbidities. The SA group spent less time in the OR (163.86 ± 9.02 vs. 195.63 ± 11.27 min, p < 0.05), PACU (82.00 ± 7.17 vs. 102.98 ± 8.46 min, p < 0.05), and under anesthesia (175.03 ± 9.31 vs. 204.98 ± 10.15 min, p < 0.05) than the GA group. Post-surgery OR time was significantly less with SA than with GA (6.00 ± 1.09 vs. 17.26 ± 3.05 min, p < 0.05); however, pre-surgery OR time was similar between groups (50.17 ± 3.08 vs. 56.17 ± 5.34 min, p = 0.061). The SA group also experienced less maximum postoperative pain (3.31 ± 1.41 out of 10 vs. 5.96 ± 0.84/10, p < 0.05) and required less opioid analgesics (2.38 ± 1.37 vs. 5.39 ± 0.84 doses, p < 0.05). Both groups experienced similar nausea or vomiting rates and adverse events postoperatively. Net operative cost was found to be $812.31 (5.6%) less with SA than with GA, although this difference was not significant (p = 0.225).

Discussion/conclusion: To our knowledge, SA is almost never used in lumbar fusion, and a cost-effectiveness comparison with GA has not been recorded. In this retrospective study, we demonstrate that the use of SA in lumbar fusion surgery leads to significantly shorter operative and recovery times, less postoperative pain and opioid usage, and slight cost savings over GA. Thus, we conclude that this anesthetic modality represents a safe and cost-effective alternative to GA in lumbar fusion.

Keywords: Comparative outcome analysis; General anesthesia; Lumbar fusion; Spinal anesthesia; Spine surgery.

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Figures

Fig. 1
Fig. 1
Initial, Max, and End Pain score comparison. Patients in the PACU reported their pain scores upon entering and leaving the PACU, as well as throughout their stay. Max pain score and pain leaving the PACU was significantly lower in the SA group.
Fig. 2
Fig. 2
Total Cost Comparison. Comparison of total costs of SA and GA. Lumbar fusion surgeries utilizing SA as the anesthetic technique cost $812.31 less, or provided a cost savings of 5.6%.
Fig. 3
Fig. 3
Itemized cost comparison for SA and GA. Detailed cost comparison in SA and GA in terms of Total Direct Cost (TDC), PACU cost, and Anesthesia cost. PACU cost and Anesthesia cost were significantly lower in SA compared to GA.

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References

    1. Jellish W.S., Thalji Z., Stevenson K. A prospective randomized study comparing short- and intermediate-term perioperative outcome variables after spinal or general anesthesia for lumbar disk and laminectomy surgery. Anesth Analg. 1996 Sep;83(3):559–564. - PubMed
    1. McLain R.F., Bell G.R., Kalfas I. Complications associated with lumbar laminectomy: a comparison of spinal versus general anesthesia. Spine. 2004 Nov 15;29(22):2542–2547. (Phila Pa 1976) - PubMed
    1. McLain R.F., Kalfas I., Bell G.R. Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients. J Neurosurg Spine. 2005 Jan;2(1):17–22. - PubMed
    1. McLain R.F., Tetzlaff J.E., Bell G.R. Microdiscectomy: spinal anesthesia offers optimal results in general patient population. J Surg Orthop Adv. 2007;16(1):5–11. Spring. - PubMed
    1. De Rojas J.O., Syre P., Welch W.C. Regional anesthesia versus general anesthesia for surgery on the lumbar spine: a review of the modern literature. Clin Neurol Neurosurg. 2014 Apr;119:39–43. doi: 10.1016/j.clineuro.2014.01.016. - DOI - PubMed

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