The Hitchhiker's Guide to Spine Awake Surgery. The Oxford SAS Protocol and Early Outcomes

Abstract

Spine Awake Surgery (SAS) aims to achieve faster recovery times, better outcomes, and a lesser economic impact on society. Our drive to establish SAS was to improve patient outcomes and health economics, during the COVID 19 pandemic. After a systematic review and to the best of our knowledge, SAS The Oxford Protocol is the first protocolised pathway that aims to train bespoke teams performing SAS safely, efficiently and in a standardised repeatable fashion. A pilot study designed around newly derived protocols and simulated training to determine if SAS is a safe and implementable pathway to improve patient outcomes and health economics. We assessed a cohort of 10 patients undergoing one-level lumbar discectomies and decompressions, analysing the related costs, length of stay, complications, pain management and patient satisfaction. The age range of our patients was 46-84 years. Three discectomies and seven central canal stenosis decompressions. Eight patients were discharged on the same day. All patients gave positive feedback about their experience of SAS. A significant cost saving was made compared to a GA overnight stay across the group. No on day cancellations occurred due to lack of bed availability. No patient needed analgesia in the recovery room or needed additional analgesia over and above the SAS e-prescription take home package. Our early experience and journey reinforce our drive to push forward and expand on this process. It aligns with the international literature which highlights this approach as safe, efficient, and economical.