Spine J. 2022 May 4:S1529-9430(22)00172-3. doi: 10.1016/j.spinee.2022.04.012. Online ahead of print.
ABSTRACT
BACKGROUND CONTEXT: Awake spine surgery is growing in popularity, and may facilitate earlier postoperative recovery, reduced cost, and fewer complications than spine surgery conducted under general anesthesia (GA). However, trends in adoption of awake (ie, non-GA) spine surgery have not been previously studied.
PURPOSE: To investigate temporal trends in non-GA spine surgery utilization and outcomes in the United States.
STUDY DESIGN/SETTING: A retrospective observational study.
PATIENT SAMPLE: PATIENTS: undergoing cervical or lumbar decompression or/and fusion from the American College of Surgeons National Surgical Quality Improvement Program database records dated 2005-2019.
OUTCOME MEASURES: The primary outcome was adoption trends of awake cervical and lumbar spine operations from 2005 to 2019. The secondary outcomes included the outcomes trends of 30-day complications, readmission rates, and length of stay in cervical and lumbar spine operations from 2005 to 2019.
METHODS: Patients were stratified into 2 groups: GA and non-GA (regional, epidural, spinal, monitored anesthesia care/intravenous sedation). Pearson chi-squared or Fisher exact test and independent sample t test were used to compare demographics between groups. Jonckheere-Terpstra test was used to determine whether trends and outcomes of non-GA operations from 2005-2019 were statistically significant. No non-GA spine operations were reported in the database during 2005-2006.
RESULTS: We included 301,521 patients who underwent cervical or lumbar spine operations from 2005-2019. GA was used in 294,903 (97.8%) operations; 6,618 (2.2%) operations were non-GA. Patients in the non-GA cohort were more likely to be younger (50.1 vs. 57.2 years; P<0.001), less likely to have American Society of Anesthesiologists classification ≥3 (39.7% vs. 48.3%; P<0.001), and to have lower BMI (27.8 vs. 31.5 kg/m2; P<0.001), outpatient admission status (10.8% vs. 4.0%; P<0.001), and fewer bleeding disorders (0.0% vs. 1.2%; P<0.001). The proportion of non-GA spine operations increased from nearly 0% in 2005 to 2.1% in 2019. The increase in non-GA operations was statistically significant in cervical (0.0% to 1.1%) and lumbar (0.0% to 2.9%) operations. For non-GA lumbar operations performed 2007-2019, 30-day complication rates, readmission rates, and mean length of stay all decreased (19.1% to 5.4%, P<0.05; 5.9% to 2.8%, P<0.05; 30.9 hours to 24.9 hours, P<0.05, respectively). Similarly, for non-GA cervical operations performed 2007-2019, 30-day complication rates, readmission rates, and mean length of stay all decreased (20.1% to 6.1%, P<0.05; 6.7% to 3.7%, P <0.05; 27.0 to 20.0 hours P<0.05, respectively).
CONCLUSIONS: Our trends analysis revealed increasing utilization and improved outcomes of non-GA spine surgery from 2005-2019; however, the proportion of non-GA spine operations remains small. Future research should investigate the barriers to adoption of non-GA spine surgery.
PMID:35525378 | DOI:10.1016/j.spinee.2022.04.012
