Waseem Wahood1, Yagiz Yolcu1, Mohammed Ali Alvi1, Anshit Goyal1, Timothy R Long2, Mohamad Bydon3. 1. Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA. 2. Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA. 3. Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: bydon.mohamad@mayo.edu.
Abstract
OBJECTIVES: Endotracheal/general anesthesia is one of the most commonly used anesthetic techniques when performing thoracic and lumbar surgeries. However, spinal and epidural (non-general) anesthesia have been increasingly employed for lumbar decompressions (LD) and lumbar fusion recently. The objective of this study was to investigate the outcomes of general and non-general anesthesia in patients undergoing posterior lumbar fusion (PLF) and LD using a national registry. PATIENTS AND METHODS: ACS-NSQIP database was queried to identify patients who underwent LD or PLF with general or non-general anesthesia between 2011-2015. Patient characteristics and postoperative variables were compared. Multivariable regression was used to identify predictors of thirty-day readmission, any complication and length of 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). 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. Anesthesia type 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). CONCLUSION: Our analysis showed that non-general anesthesia had equivalent outcomes with respect to readmission, LOS and complications 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 may be practiced safely and is associated with equivalent outcomes.
OBJECTIVES: Endotracheal/general anesthesia is one of the most commonly used anesthetic techniques when performing thoracic and lumbar surgeries. However, spinal and epidural (non-general) anesthesia have been increasingly employed for lumbar decompressions (LD) and lumbar fusion recently. The objective of this study was to investigate the outcomes of general and non-general anesthesia in patients undergoing posterior lumbar fusion (PLF) and LD using a national registry. PATIENTS AND METHODS: ACS-NSQIP database was queried to identify patients who underwent LD or PLF with general or non-general anesthesia between 2011-2015. Patient characteristics and postoperative variables were compared. Multivariable regression was used to identify predictors of thirty-day readmission, any complication and length of 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). 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. Anesthesia type 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). CONCLUSION: Our analysis showed that non-general anesthesia had equivalent outcomes with respect to readmission, LOS and complications 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 may be practiced safely and is associated with equivalent outcomes.