Comparative effectiveness of anesthetic technique on outcomes after lumbar spine surgery: a retrospective propensity score-matched analysis of the National Surgical Quality Improvement Program, 2009–2019

Abstract

BackgroundThe impact of anesthetic technique on spine surgery outcomes is controversial. Using a large national sample of patients, we compared outcomes after lumbar decompression under regional anesthesia (RA: spinal or epidural) or general anesthesia (GA).MethodsA retrospective population-based study of American College of Surgeons National Surgical Quality Improvement Program data (2009–2019). Patients were propensity score (PS) matched 3:1 (GA:RA) on demographic and surgical variables. The primary outcome was the association between anesthetic type and any complication (cardiac, pulmonary, renal, transfusion, stroke, infectious, deep vein thrombosis/pulmonary embolus). Secondary outcomes included the association between anesthetic type and individual complications, readmission and length of stay (LOS). Unadjusted comparisons (OR, 95% CI), logistic regression and adjusted generalized linear modeling (parameter estimate, PE, 95% CI) were performed before and after PS matching.ResultsOf 1 51 010 cases, 149 996 (99.3%) were performed under GA, and 1014 (0.67%) under RA. After matching, 3042 patients with GA were compared with 1014 patients with RA. On unadjusted analyses, RA was associated with lower odds of complications (OR 0.43, 0.3 to 0.6, p<0.001), shorter LOS (RA: 1.1±3.8 days vs GA: 1.3±3.0 days; p<0.001) and fewer blood transfusions (RA: 3/1014, 0.3% vs GA: 40/3042, 1.3%; p=0.004). In adjusted analyses, RA was associated with fewer complications (PE −0.43, –0.81 to −0.06, p=0.02) and shorter LOS (PE −0.76, –0.90 to −0.63, p<0.001). There was no significant association between anesthetic type and readmission (PE −0.34, –0.74 to 0.05, p=0.09).ConclusionsCompared with GA, RA was associated with fewer complications, less blood transfusion and shorter LOS after spine surgery. Although statistically significant, the magnitude of effects was small and requires further prospective study.

Spine surgery under neuraxial vs. general anesthesia: the current state of comparative outcomes research

“…Two large population-based studies extracted data from the National Surgical Quality Improvement Program to describe recent trends in use of neuraxial anesthesia vs. general anesthesia and to compare outcomes and complications after spine surgery according to anesthetic type [14 ▪▪ ,15 ▪▪ ]. The first reported trends in the use of general anesthesia and non-general anesthesia among 301 521 patients undergoing all types of spine surgery, including lumbar, thoracic and/or cervical procedures (2005--2019) [14 ▪▪ ].…”

“…The authors found progressive utilization of non-general anesthesia over time for all subtypes of spine surgery together with significant reductions in length of hospital stay, readmission and 30-day complications among patients undergoing lumbar spine surgery. The second study assessed the impact of anesthetic technique on outcomes after lumbar decompression under spinal or epidural anesthesia compared to general anesthesia in 151 010 patients (2009--2019) [15 ▪▪ ]. Compared with general anesthesia, neuraxial anesthesia was associated with fewer complications, less blood transfusion and shorter length of stay after surgery, without significant differences in readmission.…”

“…This has long been recognized as a source of bias in large observational studies, which rely on proper coding of anesthetic technique, and do not necessarily include codes for sedation when neuraxial anesthesia is provided [27]. Similarly, for patients receiving general anesthesia, important outcomes may be influenced by the choice of inhalational (volatile) or total intravenous anesthesia [28], and these details are not available within the databases used for the population research reviewed here [14 ▪▪ ,15 ▪▪ ]. Likewise by reference to the clinical studies (Table 1), it is evident that ‘sedation’ is not standardized, and spans descriptions from ‘not reported’, ‘at the discretion of the anesthesiologist’, and/or includes combinations of opioids, benzodiazepines, propofol and/or dexmedetomidine.…”

Effect of regional block technique on postoperative high-grade complications according to Clavien-Dindo classification in elderly patients with thoracic and abdominal cancer: a retrospective propensity score matching analysis

“…Such Clinical recommendations are often based on evidence derived from meta-analysis of randomized controlled trials (RCTS) but their interpretation is often hindered by the fact that they do not always consider current clinical relevance ( 9 ). Recently, a few studies have found that the use of regional blocks can reduce the incidence of postoperative complications in patients with real data ( 10 ), however, the findings are more limited to orthopedic surgery and do not grade the severity of complications in them ( 11 , 12 ). The same complications may have different levels of severity with different levels of management.…”

#36984 PRO-CON – fascial plane blocks: are they effective?

“…Recent case reports after a terminated prospective trial should be a warning to all that FPBs' relative safety is not absolute. 24…”