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  • Spinal anesthesia for lumbar spine surgery: decreased medication use, need for hemodynamic support and total cost of care, a single center experience

    Final Number:
    4039

    Authors:
    Jean-Valery Coumans MD; Hao Deng MBBS, MPH; Robert A Peterfreund MD PhD; Matthias MD Eikermann; Khushi S Chhangani BS; Riichard Anderson MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting - Late Breaking Science

    Introduction: We commonly administer spinal anesthesia for routine lumbar spine surgeries. Compared to general anesthesia, anecdotal impressions suggested that patients received fewer anesthesia –administered medications, including vasopressors, during spinal anesthesia. We hypothesized that data review would confirm these impressions. This case-control study compared specific elements of spinal versus general anesthesia for 1-2 level lumbar spine procedures. We performed a cost analysis to compare the cost of spinal and general anesthesia in a large cohort of patients.

    Methods: With IRB approval, we electronically identified all patients undergoing lumbar foraminotomy, discectomy, or simple decompression by a single surgeon over 8 years. An automatic structured query of our electronic record extracted pre-specified data elements.

    Results: Searching found 144 spinal anesthesia (median age 69.5, 67 women) and 619 (median age 65.0, 240 women) general anesthesia cases. The total number of drugs administered by the anesthesiologist was 10 ± 2 for general and 5 ± 2 for spinal anesthetics (p<0.001, negative binomial model). Multivariate analysis supported this finding (spinal anesthesia -4.37, 95% CI -4.75 to -4.00). Spinal anesthesia patients were less likely to receive ephedrine , or phenylephrine (bolus or infusion)(p<0.001, Chi Square analysis). No neurologic injuries were attributed to, or masked by, spinal anesthesia. Three spinal anesthetics failed. Spinal anesthesia was associated with 6.5% reduction in total hospital cost (95% CI 0.7% - 12.3%, P = 0.028 log-transformed two independent sample t-test).

    Conclusions: For routine lumbar surgery in our cohort, spinal compared to general anesthesia was associated with significantly fewer drugs administered during a case and less frequent use of vasopressors. Total costs of care were significantly lower. For selected cases/patients, spinal anesthesia may be a useful, less costly alternative for lumbar spine surgery.

    Patient Care: This retrospective study spanning 8 years demonstrates that spinal anesthesia is a less costly alternative in patients undergoing elective spine surgery. It is associated with half the number of drugs compared with general anesthesia, and in particular a signicicant reduction in the use of pressors. It should be considered in patients undergoing elective spinal surgery.

    Learning Objectives: 1) Understanding the advantages and shortcomings of spinal anesthesia for spinal surgery. 2) Understanding how anesthetic choice impacts hospital cost in spinal surgery patients. 3) Understanding the hemodynamic effects of different anesthetics

    References:

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