Spinal Anesthesia for Spine Surgery May Improves Outcomes, Cost

Tinker Ready

October 31, 2017

BOSTON — Use of spinal anesthesia instead of general anesthesia for spine surgery improved patient recovery and reduced costs by nearly 10%, according to the results of a single-institution study presented here at Anesthesiology 2017 from the American Society of Anesthesiologists.

More than half of the higher cost of general anesthesia was linked to time in the operating room, the researchers reported.

"We found that there were some pretty consistent findings across the board in terms of spinal versus general [anesthesia]," said Matthew Morris, from Montefiore Medical Center in New York, who presented the study. Morris and members of the research team are also affiliated with the Albert Einstein College of Medicine in New York.

With spinal anesthesia "you can get out of the operating room in a short amount of time, you can get out of the [post anesthesia care unit (PACU)] in a short amount of time," Morris said.

The researchers noted that general anesthesia (GA) has "traditionally been preferred, perhaps in part due to surgeon preference, anesthesiologist comfort level, and patient perception of the standard of care." Yet previous research indicates that spinal anesthesia (SA) is a safe alternative to GA for these procedures.  

"However, a lack of research comparing these two modalities in terms of cost and clinical outcomes precludes a determination of their relative cost-effectiveness," the authors say.

Therefore, Morris and colleagues retrospectively examined demographic and clinical data for 188 patients who underwent lumbar laminectomy or discectomy procedures performed by a single surgeon between 2012 and 2016. Patients were grouped based on type of anesthesia.

The investigators looked at estimated blood loss, incidence of dural tears, anesthesia time, operating room time, and surgical time. Postoperative data analyzed included PACU time, pain scores, analgesic use, incidence of nausea and vomiting, urinary retention, spinal headache, and 30-day readmission.

Costs were calculated using hospital expenses directly related to patient care. ""The team worked with hospital finance staff and looked at variable expenses that could be subject to change. They looked at direct costs — like the anesthesiologist's fee — rather than overhead costs.

A total of 97 patients received SA and 91 received GA. The SA group spent less time in the operating room (138 ± 6 vs 177 ± 17 min, P < .05), in the PACU (212 ± 15 vs 259 ± 29 min, P < .05), and under anesthesia (149 ± 5 vs 180 ± 7 min, P < .05) than the GA group.

The SA group also reported less postoperative pain (0.64/10 ± 0.38 vs 3.13/10 ± 0.81, P < .05) and required fewer opioids (1.13 ± 0.36 vs 4.30 ± 0.86 doses, P < .05).  

Net costs were $8,446.14 ± 269.99 with SA and $9,284.75 ± 436.58 with GA (P < .05), for a savings of 9.93%.

However, Elisabeth Abramowicz, MD, professor of clinical anesthesiology at New York Medical College, said she was troubled by what she saw as a higher rate of dural tears in the surgery using SA. There were 4.12 ductal tears in the SA group and 2.2 in the GA group (P < .453). The researchers concluded that the incidence of dural tears was similar in both groups.

"I don't care if you save $50 per cases," said Dr Abramowicz, who was not involved in the study. "This is a big deal that has to be addressed."

Morris said that the choice between the two types of anesthesia should depend on how comfortable the surgical team is with either approach. "If you feel uncomfortable doing (SA), you shouldn't," he said. "If you feel comfortable doing this, it is absolutely safe and effective and can save on hospital costs."

The authors have disclosed no relevant financial relationships.

Anesthesiology 2017 from the American Society of Anesthesiologists: Abstract 2051. Presented October 23, 2017.

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