Defining the time benefit of awake versus general anesthesia in single level lumbar spine surgery.

Abstract INTRODUCTION Lumbar spine surgery can be successfully performed using various anesthetic techniques. Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia (SA) to general anesthesia (GA) in lumbar surgery. We sought to elucidate the more expedient anesthetic technique. METHODS Following IRB approval, a retrospective review of patients undergoing elective lumbar decompression surgery using GA or SA was performed. Demographic data known to influence perioperative morbidity was collected as well as safety and efficiency parameters. After controlling for patient and procedure characteristics, simple linear and multivariate regression analyses were performed to identify differences in operative blood loss, operative time, time from entering the OR until incision, time from bandage placement to exiting the OR, total anesthesia time, time in the post-anesthesia care unit (PACU), and length of hospital stay. RESULTS >544 consecutive lumbar laminectomy and discectomy surgeries were identified with 183 undergoing GA and 361 undergoing SA. The following times were all shorter for patients receiving SA than GA: operative time (97.4 vs. 151.8 min., P < 0.001), total anesthesia time (145.6 vs. 217.5 min., P < 0.001), time from entering the OR until incision (38.3 vs. 46.8 min., respectively, P < 0.001), time from bandage placement until exiting the OR (10.2 vs. 17.2 min., P < 0.001), and length of hospital stay (1.5 vs. 3.1 days, P < 0.001). The mean PACU length of stay was longer in the SA group than the GA group (178.0 vs. 116.5 min., P < 0.001). Estimated blood loss was less in the SA group than the GA group (62.1 vs. 176.3 mL, P < 0.001). CONCLUSION Spinal anesthesia may be the more expedient method of anesthesia in lumbar spinal surgery for all perioperative time points except for time in the PACU.

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Spinal vs General Anesthesia in Lumbar Spine Surgery: A Multicenter Cost-Effectiveness Analysis

The Spine Journal ◽

10.1016/j.spinee.2017.07.286 ◽

2017 ◽

Vol 17 (10) ◽

pp. S200

Author(s):

Matthew Morris ◽

Jonathan Morris ◽

Woojin Cho ◽

Manal Abouelrigal ◽

Camari Wallace ◽

...

Keyword(s):

Cost Effectiveness ◽

Lumbar Spine ◽

General Anesthesia ◽

Spine Surgery ◽

Cost Effectiveness Analysis ◽

Lumbar Spine Surgery ◽

Effectiveness Analysis

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Perioperative outcome and cost-effectiveness of spinal versus general anesthesia for lumbar spine surgery

Neurologia i Neurochirurgia Polska ◽

10.1016/j.pjnns.2014.05.005 ◽

2014 ◽

Vol 48 (3) ◽

pp. 167-173 ◽

Cited By ~ 23

Author(s):

Kadriye Kahveci ◽

Cihan Doger ◽

Dilsen Ornek ◽

Derya Gokcinar ◽

Semih Aydemir ◽

...

Keyword(s):

Cost Effectiveness ◽

Lumbar Spine ◽

General Anesthesia ◽

Spine Surgery ◽

Lumbar Spine Surgery ◽

Perioperative Outcome

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Ambulation on Postoperative Day #0 Is Associated With Decreased Morbidity and Adverse Events After Elective Lumbar Spine Surgery: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Neurosurgery ◽

10.1093/neuros/nyz501 ◽

2019 ◽

Vol 87 (2) ◽

pp. 320-328 ◽

Cited By ~ 2

Author(s):

Hesham Mostafa Zakaria ◽

Michael Bazydlo ◽

Lonni Schultz ◽

Muwaffak Abdulhak ◽

David R Nerenz ◽

...

Keyword(s):

Lumbar Spine ◽

Adverse Events ◽

Spine Surgery ◽

Postoperative Care ◽

Enhanced Recovery ◽

Cost Savings ◽

Lumbar Spine Surgery ◽

Lumbar Surgery ◽

Single Level ◽

Vein Thrombosis

Abstract BACKGROUND While consistently recommended, the significance of early ambulation after surgery has not been definitively studied. OBJECTIVE To identify the relationship between ambulation on the day of surgery (postoperative day (POD)#0) and 90-d adverse events after lumbar surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective multicenter registry of spine surgery patients. As part of routine postoperative care, patients either ambulated on POD#0 or did not. The 90-d adverse events of length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), pulmonary embolism/deep vein thrombosis (PE/DVT), and disposition to a rehab facility were measured. RESULTS A total of 23 295 lumbar surgery patients were analyzed. POD#0 ambulation was associated with decreased LOS (relative LOS 0.83, P < .001), rehab discharge (odds ratio [OR] 0.52, P < .001), 30-d (OR 0.85, P = .044) and 90-d (OR 0.86, P = .014) readmission, UR (OR 0.73, P = 10), UTI (OR 73, P = .001), and ileus (OR 0.52, P < .001) for all patients. Significant improvements in LOS, rehab discharge, readmission, UR, UTI, and ileus were observed in subset analysis of single-level decompressions (4698 pts), multilevel decompressions (4079 pts), single-level fusions (4846 pts), and multilevel fusions (4413 pts). No change in rate of SSI or DVT/PE was observed for patients who ambulated POD#0. CONCLUSION POD#0 ambulation is associated with a significantly decreased risk for several key adverse events after lumbar spine surgery. Decreasing the incidence of these outcomes would be associated with significant cost savings. As ambulation POD#0 is a modifiable factor in any patient's postoperative care following most spine surgery, it should be encouraged and incorporated into spine-related, enhanced-recovery-after-surgery programs.

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