(I-704) Spinal Anesthesia in Lumbar Surgery Improves Post-Operative Patient-Reported Outcomes: a Single-Institution Analysis of the Quality Outcomes Database

Introduction: While spinal anesthesia (SA) has shown numerous benefits over general anesthesia (GA), the efficacy of SA in improving the patient’s surgical experience and improving satisfaction scores remains unclear. In this study, utilize the Quality Outcomes Database (QOD) to determine how SA affects PROMs in lumbar surgery.

Methods: With the permission of the NeuroPoint Alliance QOD, 822 lumbar surgeries submitted by our institution were re-identified, and the anesthetic modality was determined (149 SA, 673 GA). Minimum follow-up time was 3 months. Nearest neighbor propensity score matching with replacement was performed based on age, sex, BMI, ambulatory status, ASA, number of surgical levels, arthrodesis, operative time, and length of stay. Outcome measures included pain VAS scores, quality of life, Oswestry Disability Index (ODI), return to work, and the North American Spine Society (NASS) patient satisfaction index which were compared between the SA and GA cohorts.

Results: In the propensity score matched cohort, 37 SA cases were compared with 58 cases under GA. A significantly larger proportion of patients in the SA group achieved a minimally clinically important difference (MCID) in leg pain compared to GA (74% vs. 92%, respectively; p=0.035) and returned to work by 3 months (60% vs. 89%, respectively; p=0.030). At 3 months, the SA group also had a significantly higher percentage of patients who reported maximal satisfaction (NASS=1) at 3 months, when compared to the GA group (76% vs. 48%; p=0.008). There was no significant difference between groups with regard to back pain, quality of life, or ODI at 3 months.

Conclusion : Patients who underwent lumbar procedures using SA had favorable MCID in post-operative pain, returned to work sooner, and had superior satisfaction scores compared to GA. These results suggest that awake spine surgery provides a comfortable surgical experience, yields favorable post-operative outcomes, and leads to superior patient satisfaction.

How to Improve Patient Care: Spinal anesthesia for elective lumbar surgery provides comparable, and in some cases, superior patient satisfaction scores and outcomes when compared to general anesthesia.