Propofol TIVA vs. inhalational anesthesia for spine surgery: in‑hospital mortality and postoperative complications in a nationwide Korean cohort

Background Given propofol’s antioxidant and anti‑inflammatory properties compared with volatile/inhalational agents, we aimed to evaluate the association between anesthetic technique and both in‑hospital mortality and postoperative complications following spinal surgery. Methods In this retrospective, population‑based cohort study, we used South Korea’s National Health Insurance Service database to identify adult patients (≥ 18 years) who underwent spinal surgery between January 1, 2016 and December 31, 2021. Primary outcomes were in‑hospital mortality and postoperative complications. Propensity score (PS) matching (1:1) was employed to balance baseline characteristics between the total intravenous anesthesia (TIVA) and volatile/inhalational anesthesia (INH) groups. Results Among 708,387 patients, 264,728 (37.4%) received TIVA and 443,659 (62.6%) received INH. After PS matching, 460,654 patients remained (230,327 per group). In the PS‑matched cohort, TIVA was associated with significantly lower odds of in‑hospital mortality (OR 0.85; 95% CI 0.80–0.89; P = 0.004) and postoperative complications (11.8% vs. 14.2%; OR 0.81; 95% CI 0.80–0.82; P < 0.001) compared with INH. In the full cohort, multivariable logistic regression confirmed these findings: TIVA remained linked to reduced in‑hospital mortality (OR 0.74; 95% CI 0.63–0.87; P < 0.001) and fewer postoperative complications (OR 0.71; 95% CI 0.70–0.73; P < 0.001). Conclusions In this nationwide cohort, propofol‑based TIVA was associated with lower in‑hospital mortality and fewer postoperative complications than volatile/inhalational anesthesia in adult spinal surgery patients. Prospective trials are warranted to confirm these findings. Trial registration : Not applicable.