Introduction: Endotracheal anesthesia is one of the most commonly used anesthetic techniques when performing thoracic and lumbar surgeries. However, spinal and epidural anesthesia(non-general) have recently been increasingly used for lumbar decompressions and lumbar fusion. They are much more cost-effective than general anesthesia, but much more difficult to perform. The objective of this study was to investigate the outcomes of general and non-general(spinal and epidural) anesthesia in patients undergoing posterior lumbar fusion(PLF) and lumbar decompression(LD) using a national registry.
Methods: The American College of Surgeons National Surgical Quality and Improvement Program(NSQIP) database was queried to identify patients who underwent LD or PLF with general or non-general anesthesia between 2011 and 2015. Patient characteristics and postoperative variables were compared. Multivariable regression was used to identify predictors of thirty-day readmission, any complication and length of hospital stay(LOS). Three-to-one propensity-score matching and conditional logistic regression were used to adjust for potential bias.
Results: A total of 60,222 patients who underwent LD were identified; 59,876(99.4%) received general anesthesia and 342(0.6%) were given non-general anesthesia. On multivariable conditional regression, type of anesthesia was found to have no significant effect on any of the outcomes analyzed(Readmission: OR: 0.90, p=0.79; Any Complication: OR: 0.75, p=0.75; LOS: Coef.: 0.18, p=0.35, respectively). A total of 31,419 patients who underwent PLF were identified; 31,377(99.9%) were given general anesthesia and 42(0.1%) were given non-general anesthesia. The type of anesthesia had no significant effect on any of the outcomes analyzed(Readmission: OR: 0.78, p=0.83; Any Complication: OR: 0.50, p=0.40; LOS: Coef.: 0.17, p=0.68, respectively).
Conclusions: Our analysis showed that non-general anesthesia had equivalent outcomes with respect to readmission, LOS, or any complication, when compared to general anesthesia in patients undergoing LD or PLF. While the choice of anesthesia type remains a matter of preference, our results show that non-general anesthesia is associated with equivalent outcomes.
Patient Care: Physicians can gain a better understanding of assessing risk factors of patients before choosing a proper anesthetic technique. Thus, this will improve patient outcomes by reducing complications.
Learning Objectives: Participants are expected to:
1) Recognize the effect of using general vs non-general anesthesia in LD and PLF in terms of clinical outcomes
2) Recognize complications resulting from using general or non-general anesthesia
3) Gain a better understanding of assessing risk factors of patients before choosing a proper anesthetic technique