Key result
Spinal anesthesia for geriatric lumbar spine surgery significantly reduced estimated blood loss by 75 mL, shortened postanesthesia care unit stays, and lowered maximum pain scores compared to general anesthesia, with similar complication rates.
Why the study?
Spinal anesthesia may reduce perioperative complications during elective lumbar spine surgery, but few studies have compared spinal anesthesia with general anesthesia in an elderly population.
Does spinal anesthesia improve perioperative outcomes compared to general anesthesia in elderly patients undergoing lumbar spine surgery?
Cohort (n=295)
No
Does spinal anesthesia improve perioperative outcomes compared to general anesthesia in elderly patients undergoing lumbar spine surgery?
Spinal anesthesia is a safe alternative to general anesthesia for geriatric lumbar spine surgery, associated with reduced blood loss, shorter recovery room stays, and lower pain scores.
May support SA feasibility versus GA in elderly lumbar surgery; hypothesis-generating, prospective RCTs needed before practice change.
Background: The use of spinal anesthesia (SA) as opposed to general anesthesia (GA) during elective lumbar spine surgery is an emerging technique and represents a potentially modifiable factor to limit perioperative complications. Few studies, however, have compared these anesthetic techniques in an elderly population. The aim of this study is to determine if SA is a safe alternative to GA for lumbar spine surgery in elderly patients. Methods: A retrospective, consecutive case series study was performed. All patients aged 70 years and older who underwent lumbar spine decompression or combined decompression and fusion using either SA or GA during a 2-year period at a single institution were identified. Demographics and perioperative outcomes were compared. Results: Of all patients meeting the inclusion criteria, 56 patients (19%) received SA and 239 (81%) received GA. Patients receiving SA were slightly older (median age, 77 years versus 75 years, P = .002), consisted of more men (57% versus 36%, P = .01), and had a lower mean body mass index (28.3 versus 30.1, P = .03). Indications for surgery and type of surgery were similar between groups. On average, operative times with SA were 101 minutes versus 103 minutes with GA (P = .71). After controlling for age, sex, and body mass index, patients receiving SA had decreased estimated blood loss (β = −75 mL; 95% confidence interval [CI], −140.6, −9.4; P = .025) and intraoperative intravenous fluid requirements (β = −205 mL; 95% CI, −389.4, −21.0; P = .029), shorter postanesthesia care unit stays (β = −41 minutes; 95% CI, −64.6, −16.9; P = .001), lower maximum visual analog scale pain scores (β = −0.89 points; 95% CI, −1.6, −0.1; P = .020), and decreased odds of receiving blood transfusion (odds ratio, 0.12; 95% CI, 0.01, 0.62; P = .45); there were no significant differences in operative time, length of stay, nausea, or oral morphine equivalents consumed per day. Complication rates were similar between groups. Conclusion: Spinal anesthesia is a reasonable, safe alternative to general anesthesia for lumbar spine surgery in elderly patients with degenerative conditions.
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Lessing et al. (2020) conducted a cohort in Degenerative lumbar spine pathology requiring decompression or fusion (n=295). Spinal anesthesia vs. General anesthesia was evaluated on Estimated blood loss (MD -75, 95% CI -140.6 to -9.4, p=0.025). Spinal anesthesia for geriatric lumbar spine surgery significantly reduced estimated blood loss by 75 mL, shortened postanesthesia care unit stays, and lowered maximum pain scores compared to general anesthesia, with similar complication rates.
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