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Ghaith AK, Akinduro OO, El-Hajj VG, De Biase G, Ghanem M, Rajjoub R, Faisal UH, Saad H, Abdulrahim M, Bon Nieves A, Chen SG, Pirris SM, Bydon M, Abode-Iyamah K. General Versus Nongeneral Anesthesia for Spinal Surgery: A Comparative National Analysis of Reimbursement Trends Over 10 Years. Neurosurgery 2024; 94:413-422. [PMID: 37856210 DOI: 10.1227/neu.0000000000002670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/13/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Nongeneral anesthesia (non-GA) spine surgery is growing in popularity and has facilitated earlier postoperative recovery, reduced cost, and fewer complications compared with spine surgery under general anesthesia (GA). Changes in reimbursement policies have been demonstrated to correlate with clinical practice; however, they have yet to be studied for GA vs non-GA spine procedures. We aimed to investigate trends in physician reimbursement for GA vs non-GA spine surgery in the United States. METHODS We queried the ACS-NSQIP for GA and non-GA (regional, epidural, spinal, and anesthesia care/intravenous sedation) spine surgeries during 2011-2020. Work relative value units per operative hour (wRVUs/h) were retrieved for decompression or stabilization of the cervical, thoracic, and lumbar spine. Propensity score matching (1:1) was performed using all baseline variables. RESULTS We included 474 706 patients who underwent spine decompression or stabilization procedures. GA was used in 472 248 operations, whereas 2458 operations were non-GA. The proportion of non-GA spine operations significantly increased during the study period. Operative times ( P < .001) and length of stays ( P < .001) were shorter in non-GA when compared with GA procedures. Non-GA lumbar procedures had significantly higher wRVUs/h when compared with the same procedures performed under GA (decompression; P < .001 and stabilization; P = .039). However, the same could not be said about cervicothoracic procedures. Lumbar decompression surgeries using non-GA witnessed significant yearly increase in wRVUs/h ( P < .01) contrary to GA ( P = .72). Physician reimbursement remained stable for procedures of the cervical or thoracic spine regardless of the anesthesia. CONCLUSION Non-GA lumbar decompressions and stabilizations are associated with higher and increasing reimbursement trends (wRVUs/h) compared with those under GA. Reimbursement for cervical and thoracic surgeries was equal regardless of the type of anesthesia and being relatively stable during the study period. The adoption of a non-GA technique relative to the GA increased significantly during the study period.
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Affiliation(s)
- Abdul Karim Ghaith
- Department of Neurological Surgery, Mayo Clinic, Rochester , Minnesota , USA
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester , Minnesota , USA
| | | | - Victor Gabriel El-Hajj
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester , Minnesota , USA
- Department of Neurosurgery, Karolinska University Hospital, Stockholm , Sweden
| | - Gaetano De Biase
- Department of Neurological Surgery, Mayo Clinic, Jacksonville , Florida , USA
| | - Marc Ghanem
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut , Lebanon
| | - Rami Rajjoub
- Department of Neurological Surgery, Mayo Clinic, Rochester , Minnesota , USA
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester , Minnesota , USA
| | - Umme Habiba Faisal
- Department of Neurological Surgery, Mayo Clinic, Jacksonville , Florida , USA
| | - Hassan Saad
- Department of Neurological Surgery, Emory University, Atlanta , Georgia , USA
| | - Mostafa Abdulrahim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Antonio Bon Nieves
- Department of Neurological Surgery, Mayo Clinic, Rochester , Minnesota , USA
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester , Minnesota , USA
| | - Selby G Chen
- Department of Neurological Surgery, Mayo Clinic, Jacksonville , Florida , USA
| | - Stephen M Pirris
- Department of Neurological Surgery, Mayo Clinic, Jacksonville , Florida , USA
| | - Mohamad Bydon
- Department of Neurological Surgery, Mayo Clinic, Rochester , Minnesota , USA
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester , Minnesota , USA
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Patel J, Karimi H, Olmos M, Wiepert L, Kanter M, Hernandez NS, Frerich JM, Riesenburger RI, Kryzanski J. The Relationship of Spinal Anesthesia Dosing Based on Thecal Sac Area to Anesthetic Failure in Lumbar Surgery. Neurosurgery 2024:00006123-990000000-01036. [PMID: 38299846 DOI: 10.1227/neu.0000000000002847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/12/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Greater thecal sac volumes are associated with an increased risk of spinal anesthesia (SA) failure. The thecal sac cross-sectional area accurately predicts thecal sac volume. The thecal sac area may be used to adjust the dose and prevent anesthetic failure. We aim to assess the rate of SA failure in a prospective cohort of lumbar surgery patients who receive an individualized dose of bupivacaine based on preoperative measurement of their thecal sac area. METHODS A total of 80 patients prospectively received lumbar spine surgery under SA at a single academic center (2022-2023). Before surgery, the cross-sectional area of the thecal sac was measured at the planned level of SA injection using T2-weighted MRI. Patients with an area <175 mm2, equal to or between 175 and 225 mm2, and >225 mm2 received an SA injection of 15, 20, or 25 mg of 0.5% isobaric bupivacaine, respectively. Instances of anesthetic failure and adverse outcomes were noted. Incidence of SA failure was compared with a retrospectively obtained control cohort of 250 patients (2019-2022) who received the standard 15 mg of bupivacaine. RESULTS No patients in the individualized dose cohort experienced failure of SA compared with 14 patients (5.6%) who experienced failure in the control cohort (P = .0259). The average thecal sac area was 187.49 mm2, and a total 28 patients received 15 mg of bupivacaine, 42 patients received 20 mg of bupivacaine, and 10 patients received 25 mg of bupivacaine. None of the patients experienced any adverse outcomes associated with SA. Patients in the individualized dose cohort and control cohort were comparable and had a similar distribution of lumbar procedures and comorbidities. CONCLUSION Adjusting the dose of SA according to thecal sac area significantly reduces the rate of SA failure in patients undergoing lumbar spine surgery.
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Affiliation(s)
- Jainith Patel
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Helen Karimi
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Michelle Olmos
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Liana Wiepert
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Matthew Kanter
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Nicholas S Hernandez
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| | - Jason M Frerich
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ron I Riesenburger
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - James Kryzanski
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Liu G, Zhao J, Yuan L, Shi F, Zhang L. Spinal anesthesia for L5-S1 interlaminar endoscopic lumbar discectomy: a retrospective study. BMC Musculoskelet Disord 2023; 24:818. [PMID: 37838709 PMCID: PMC10576879 DOI: 10.1186/s12891-023-06956-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023] Open
Abstract
OBJECTIVE This study aimed to report our experience with spinal anesthesia (SA) in patients undergoing L5-S1 interlaminar endoscopic lumbar discectomy (IELD) and clarify its advantages and disadvantages. METHODS One hundred twelve patients who underwent IELD for an L5-S1 disc herniation under SA were retrospectively analyzed. SA with 0.5% ropivacaine was administered using a 27-gauge fine needle. Intraoperatively, the volume and level of SA, surgical time, blood loss, and cardiopulmonary complications were documented. Postoperative data was collected included the number of patients who ambulated on the day of surgery, incidence of complications and were then statistically analyzed. RESULTS Analgesia was complete throughout the entire operation in all patients and no other adjuvant intraoperative analgesic drugs were needed. Mean visual analog scale scores for intraoperative and early postoperative (24 h) pain were 0 and 2.43 ± 1.66. SA was administered at the L3-4 interspace in 34 patients (30.4%) and the L2-3 interspace in 78 (69.6%). Administration was successful with the first attempt in all patients. Mean operation time was 70.12 ± 6.52 min. Mean intraoperative blood loss volume was 20.71 ± 5.26 ml. Ninety-eight patients ambulated on the same day as surgery. Mean length of hospital stay was 24.36 ± 3.64 h. Dural injury without damaging the nerve root occurred in one patient. One patient experienced recurrent disc herniation. Intraoperative hypotension and respiratory distress occurred in five (4.5%) and three (2.7%) patients, respectively. Three patients (2.7%) received postoperative analgesia therapy and two (1.8%) experienced nausea. Two patients (1.8%) developed urinary retention. Spinal headache, cauda equina syndrome, and neurotoxicity did not occur. CONCLUSION SA can achieve satisfactory pain control for patients undergoing IELD with a low incidence of adverse events. SA may be a useful alternative to local and general anesthesia for IELD surgery. Future randomized controlled trials are warranted to investigate.
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Affiliation(s)
- Guanyi Liu
- Department of Orthopedics, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Jinsong Zhao
- Department of Anesthesiology, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China.
| | - Liyong Yuan
- Department of Anesthesiology, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Fangling Shi
- Department of Orthopedics, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Liangguang Zhang
- Department of Anesthesiology, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
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Hernandez NS, Begashaw B, Riesenburger RI, Kryzanski JT, Liu P. Spinal anesthesia in elective lumbar spinal surgery. Anesth Pain Med (Seoul) 2023; 18:349-356. [PMID: 37919919 PMCID: PMC10635856 DOI: 10.17085/apm.23031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 11/04/2023] Open
Abstract
Spinal anesthesia (SA) is gaining recognition as a safe and efficacious regional alternative to general anesthesia for elective lumbar surgery. However, unfamiliarity with management issues related to its use has limited the adoption of awake spine surgery, despite its benefits. Few centers in the United States routinely offer SA for elective lumbar surgery, and a comprehensive workflow to standardize SA for lumbar surgery is lacking. In this article, we examine recent literature on the use of SA in lumbar surgery, review the experience of our institution with SA in lumbar surgery, and provide a cohesive outline to streamline the implementation of SA from the perspective of the anesthesiologist. We review the critical features of SA in contemporary lumbar surgery, including selection of patients, methods of SA, intraoperative sedation, and management of several important technical considerations. We aimed to flatten the learning curve to improve the availability and accessibility of the technique for eligible patients.
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Affiliation(s)
| | - Benayas Begashaw
- Department of Anesthesiology, Tufts Medical Center, Boston, MA, USA
| | | | | | - Penny Liu
- Department of Anesthesiology, Tufts Medical Center, Boston, MA, USA
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Hong SW, Rhee KY, Kim TH, Kim SH. Back Muscle Mass as a Predictor of Postoperative Complications in Posterior Lumbar Interbody Fusion Surgery. J Clin Med 2023; 12:5332. [PMID: 37629374 PMCID: PMC10455803 DOI: 10.3390/jcm12165332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND There is a lack of studies on utilising skeletal muscle mass via preoperative lumbar computed tomography or magnetic resonance imaging as a predictor of postoperative complications of posterior lumbar interbody fusion (PLIF) surgery in elderly patients. METHODS Patients aged >65 years who underwent PLIF were enrolled. The sum of the cross-sectional areas of the erector spinae muscles (CSABoth) was presented as the skeletal muscle mass. Postoperative complications were assessed using CSABoth, pulmonary function testing, and prognostic nutritional index (PNI). RESULTS Patients with postoperative complications showed significantly lower values of CSABoth (median 2266.70 (2239.73-2875.10) mm2 vs. 3060.30 (2749.25-3473.30) mm2, p < 0.001), functional vital capacity, forced expiratory volume at 1 s, and PNI. However, multiple logistic regression analysis identified American Society of Anaesthesiologists Physical Status (ASA PS) I (odds ratio 0.307 (95% confidence interval 0.110-0.852), p = 0.023), ASA PS III (4.033 (1.586-10.254), p = 0.003), CSABoth (0.999 (0.999-1.000), p < 0.001), and postoperative red blood cell (RBC) transfusion (1.603 (1.193-2.152), p = 0.002) as risk factors for postoperative complications after PLIF surgery. CONCLUSIONS CSABoth, ASA PS III, and postoperative RBC transfusion might be used as predictors of postoperative complications after PLIF in patients aged >65 years.
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Affiliation(s)
- Seung-Wan Hong
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (S.-W.H.); (K.-Y.R.)
| | - Ka-Young Rhee
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (S.-W.H.); (K.-Y.R.)
| | - Tae-Hoon Kim
- Deparment of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea;
- Department of Medicine, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Seong-Hyop Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (S.-W.H.); (K.-Y.R.)
- Department of Medicine, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
- Department of Infection and Immunology, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
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