Introduction: Posterior lumbar fusion (PLF) is a common procedure performed by orthopedic and neurologic surgeons for a variety of spinal pathologies. Time under anesthesia can be used as a surrogate to determine length and difficulty of surgery. This analysis looked to see if time under anesthesia could be a predictor for poor outcomes. This data can be used to help surgeons map out postoperative care of their patients.
Methods: PLF cases were queried from a single institution based on the CPT codes 22630, 22633, and 22612. Cases were stratified based on time under anesthesia and separated into quintiles. Chi-square test and multivariable logistic regression were used to compare the shortest anesthesia quintile to all other quintiles for a variety of outcomes. Data were controlled for age, sex, and ASA class. A Bonferroni correction was applied, such that alpha=0.0125 and all confidence intervals were 98.75%.
Results: 3273 PLF cases were obtained for analysis. Prolonged extubation was only affected by anesthesia time for the top quintile (OR=16.88, CI:6.68-42.66, p<.0001). The 4th (OR=12.81, CI:3.48-47.19, p<.0001) and 5th (OR=59.01, CI:16.53-210.7, p<.0001) quintiles were predictors of required ICU stay. The 2nd (OR=2.14, CI:1.38-3.32, p<.0001), 3rd (OR=2.97, CI:1.95-4.54, p<.0001), 4th (OR=4.55, CI:3.01-6.89, p<.0001), and 5th (OR=10.92, CI:7.27-16.39, p<.0001) quintiles were predictors of in-hospital complications. The 2nd (OR=2.30, CI:1.48-3.58, p<.0001), 3rd (OR=3.08, CI:2.01-4.73, p<.0001), 4th (OR=4.88, CI:3.21-7.42, p<.0001), and 5th (OR=12.97, CI:8.58-19.61, p<.0001) quintiles were predictors of non-home discharge. The 2nd (OR=2.11, CI:1.32-3.37, p<.0001), 3rd (OR=2.23, CI:1.41-3.51, p<.0001), 4th (OR=3.43, CI:2.20-5.37, p<.0001) and 5th (OR=7.50, CI:4.83-11.64, p<.0001) quintiles were predictors of prolonged LOS.
Conclusions: Results indicate that time under anesthesia significantly affects perioperative and postoperative outcomes in patients who undergo PLF, but it does not play a role in post-discharge outcomes. This warrants further investigation into anesthesia time as a predictor for morbidity.
Patient Care: This research will help care team members identify potential factors that play a role in morbidity following posterior lumbar fusion. This will also help map out and plan postoperative care in patients who undergo posterior lumbar fusion.
Learning Objectives: By the conclusion of this session, participants should be able to understand the importance of anesthesia time on episode-based outcomes in patients undergoing PLF.