P138. Local anesthetic and sedation works as well as general anesthesia for lumbar spinal decompressions: a short-term analysis of outcomes

Abstract

BACKGROUND CONTEXT An increasing focus on value-based care in elective spine surgery has prompted interest in alternative modalities of surgical intervention. Avoidance of general anesthesia (GA) is one modality that has recently gained support due to reductions in postoperative symptoms related to general anesthetics. Some patients with operative spine pathology cannot tolerate a GA due to comorbidities or other issues that preclude RA or GA. Our goal was to determine the complication rate of lumbar spinal decompression under local anesthesia with IV sedation (LIS) compared to patients decompressed under general anesthesia. PURPOSE Our goal was to determine the complication rate of lumbar spinal decompression under local anesthesia with IV sedation (LIS) compared to patients decompressed under general anesthesia. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients were selected from a single surgeon's case series of lumbar decompression performed with local and sedation only and comapred to the same cases perfmed with GA at approximately the same date. OUTCOME MEASURES Outcomes reported are 90-day complications (wound complication, DVT, PE, dural tear, UTI, urinary retention, neurologic injury or recurrent stenosis) and reoperations, and postoperative narcotic use. METHODS Retrospective chart review of lumbar decompressions with at least 90-day follow up from a single surgeon was performed to evaluate patient outcomes with local anesthetic and sedation only versus GA. Outcomes reported are 90-day complications (wound complication, DVT, PE, dural tear, UTI, urinary retention, neurologic injury or recurrent stenosis) and reoperations, and postoperative narcotic use. Univariate differences between groups were assessed with chi-squared and Fisher's exact tests for categorical variables and independent samples t-tests for continuous variables. Multivariable logistic regression analyses adjusted for age, sex, body mass index (BMI), and Charlson Comorbidity Index (CCI), and any additional factors with p RESULTS A total of 65 lumbar decompression patients were identified (73.9% female, age 75.4±10.8 years): 28 local and 37 GA. The local cohort is the entire group of patients that have undergone the procedure in the past 10 years from the lead surgeon's practice. The GA patients were selected randomly for comparison. LIS patients were older (p =0.004) and more comorbid (CCI p =0.012) than those having GA. Rates of PVD and PUD were higher in local patients (p =0.004 and 0.012, respectively). Despite this, the overall rate of postoperative complications was more than 30% lower in LIS vs GA patients (local =25.0%, GA = 56.8%, p =0.013), in part due to a trend toward lower rates of recurrent stenosis in local patients (p =0.073). Rates of reoperation trended toward being lower in local (14.3%) versus GA (37.8%) patients (p =0.050). There was no difference in postoperative narcotics (local 17.9%, GA 24.3%, p =0.530). After adjusting for age, sex, BMI, CCI, and PVD, the rate of complications was still lower in the LIS group (odds ratio: 0.166 (95% CI: 0.037, 0.617), p =0.011), and the trends toward lower rates of recurrent stenosis (p =0.082) and reoperation (p =0.082) remained. There was still no difference in the rate of postoperative narcotics (p=0.5416) after adjustment. CONCLUSIONS Lumbar spinal decompressions are a commonly performed surgery and there is an increasing trend toward these being performed in the outpatient setting. The use of local anesthetic and sedation for anesthesia may have significant benefits, but there is a paucity of data analyzing spine surgery done in this manner. We analyzed the results of a single surgeon's series of lumbar spinal decompression with LIS and conclude this is a safe alternative to decompressions under general anesthesia. Further work is needed to better identity specific cost savings in LIS spine surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.