1069 Assessing the Safety and Efficacy of Spinal Anesthesia in Patients With Higher Risk Comorbidities

Abstract

INTRODUCTION: Spinal anesthesia (SA) is a safe and effective alternative to general anesthesia (GA) for lumbar surgery. Widespread adoption of SA has not occurred presumably due to surgeons’ concerns for difficulties in management of patients with comorbidities. Obesity (BMI =30 kg/m2), anxiety, obstructive sleep apnea, re-operation at the same level, and multilevel operations have recently been identified as risk factors for perioperative complications. METHODS: A retrospective analysis of 422 patients who underwent thoracolumbar surgery under spinal anesthesia by a single surgeon at a single academic center (2017-2021) was carried out. Patient demographics, comorbidities, as well as intraoperative and postoperative complications were abstracted from the medical record. In the overlapping groups, 149 patients had a BMI =30, 95 had diagnosed anxiety, 79 underwent multilevel surgery, 98 had obstructive sleep apnea, and 65 had a prior operation at the same level. The control group included 132 patients without these risk factors. Differences in perioperative outcomes were assessed with the Kruskal-Wallis rank sum test, Pearson's Chi-squared test, or Fisher's exact test using R (The R Foundation, v 4.1.1, Vienna, Austria). RESULTS: Postoperative pneumonia was observed in two patients in the anxiety group and in one patient in the reoperative group (p-value < 0.05). There were no other statistically significant differences in intraoperative and postoperative complications within the entire cohort including when stratified by number of comorbidities. Rate of spinal fusion was comparable among groups, though mean length of stay and operative time were different (p-value < 0.001). CONCLUSIONS: Spinal anesthesia is a feasible and safe anesthetic modality for most patients, including those with significant comorbidities. An updated algorithm for SA candidate selection is thus recommended.