429 - Peri-operative Characteristics and Outcomes of Patients Receiving Gene...

#429 Peri-operative Characteristics and Outcomes of Patients Receiving General Anesthesia versus Spinal Anesthesia in Single-level Lumbar Decompression

Lumbar Therapies and Outcomes

Poster Presented by: K. Singh

Author(s):

S.V. Nandyala (1)
A.J. Marquez-Lara (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Spinal and general anesthesia have both been utilized in patients undergoing lumbar spinal surgical intervention. There is limited data to determine the superiority and safety between these techniques. The purpose of this study is to compare the two methods on a national level utilizing a population-based database.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried to identify patients undergoing a lumbar decompression from 2006-2011. Procedures were identified using Current Procedural Terminology (CPT) codes involving single level surgical intervention (63042, 63047, 63030, 63087, 63047, and 63102). Two study cohorts were generated: patients induced with general anesthesia and those with spinal anesthesia. Preoperative patient characteristics, surgery and hospital course, and outcomes (operative time, length of stay (LOS)), 30-day complication rates, and mortality) were compared between groups. Statistical analysis was performed with SPSS v.20 using one-way ANOVA and χ2-tests to determine significant differences for continuous and categorical variables, respectively. Statistical significance was determined by p-values ≤ 0.05.

Results: There were 12,118 single level LDs documented in the NSQIP database. 11,855 (97.9%) patients received general anesthesia and 263 (2.1%) received spinal anesthesia. There were no significant differences in patient demographics, pre-operative health status, or laboratory values between these cohorts. The general anesthesia cohort experienced a greater mean operative time (108.1 vs 64.0 minutes; p< 0.05) compared to the spinal anesthesia group. Resident involvement was significantly greater in the spinal anesthesia cohort (p< 0.05). The general anesthesia cohort experienced a significantly greater LOS (1.8 vs 1.0 days; p< 0.05) and overall thirty-day complication rate (4.9 % vs 1.9%; p< 0.05) than spinal anesthesia cohort. The mortality index was greater in general anesthesia cohort (0.1 vs 0.0%; p=0.56) than the spinal anesthesia group but this finding was not significant.

Conclusion: This national study demonstrates that patients induced with spinal or general anesthesia in single-level lumbar decompression have comparable demographics and pre-operative health status. General anesthesia is associated with a greater mean operative time and total thirty-day complication rate. This finding may be related to more complex cases being selected for general anesthetic. Further studies are warranted to uncover safety, outcomes, and superiority between these two different anesthestic techniques.