Adoption of awake spine surgery – trends from a national registry over 14 years

Azad, Tej D.; Alomari, Safwan; Khalifeh, Jawad M.; Ahmed, A. Karim; Musharbash, Farah N.; Mo, Kevin; Lubelski, Daniel; Witham, Timothy F.; Bydon, Ali; Theodore, Nicholas

doi:10.1016/j.spinee.2022.04.012

Cited by 11 publications

(15 citation statements)

References 25 publications

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“…In addition, TETD can be performed with local anesthesia and sedation which has increased in popularity lately in select patients to facilitate early recovery pathways. 4,8,14 Thoracoscopy on the other hand requires the use of general anesthesia and single-lung ventilation. However, general anesthesia has benefits for neuromonitoring and is more comfortable for both patients and surgeons, although the ability to check a patient's response under local anesthesia may obviate the need for neuromonitoring.…”

Section: Discussionmentioning

confidence: 99%

Uniportal, Transforaminal Endoscopic Thoracic Discectomy: Review and Technical Note

Musharbash

2023

Neurospine

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Symptomatic thoracic disc herniations are a rare entity and their operative treatment is challenging. Open approaches, despite providing excellent access, are associated with significant access morbidity from thoracotomy, and this has led to an increased interest in minimally invasive techniques such as mini-open approach, thoracoscopic approach and the endoscopic approach. In this article, we describe the technical points for performing a transforaminal endoscopic thoracic discectomy and summarize its literature outcomes in the context of other minimally invasive approaches.

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Section: Discussionmentioning

confidence: 99%

Uniportal, Transforaminal Endoscopic Thoracic Discectomy: Review and Technical Note

Musharbash

2023

Neurospine

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“…1 A third study also found the length of hospital stay, the risk of 30-day complications, and readmissions to be lower in patients undergoing non-GA lumbar spine surgery as compared with those with GA, after propensity score matching. 13…”

Section: Discussionmentioning

confidence: 99%

“…This was mainly the case during the past decade, whereas the proportions tended to be more balanced in earlier periods. 13 Several studies have already highlighted the importance of a careful selection of patients in the allocation to GA vs non-GA procedures, 14,15 which leaves room for selection biases that may influence outcomes. This warrants careful consideration when interpreting such data until more solid evidence becomes available.…”

Section: Discussionmentioning

confidence: 99%

General Versus Nongeneral Anesthesia for Spinal Surgery: A Comparative National Analysis of Reimbursement Trends Over 10 Years

Ghaith,

Akinduro,

El-Hajj

et al. 2023

Neurosurgery

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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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“…An analysis of the American College of Surgeons National Surgical Quality Improvement Program database demonstrated the incidence of spine operations without general anesthesia (GA) increased from nearly 0% in 2005 to 2.1% in 2019, and that patients who underwent non-GA lumbar spine operations experienced reduced 30-day adverse effect and readmission rates and a shorter length of stay. 20 In general, there may be an opportunity to implement VR adjuncts in these non-GA spine procedures to minimize sedation, increasing the ability to perform more outpatient surgeries in ambulatory surgery centers.…”

Section: Intraoperative Utilization Of Vrmentioning

confidence: 99%

The Role of Immersive Virtual Reality on the Patient Experience and Future Applications in Spinal Care

Issa,

Lee,

Ghosh

et al. 2023

Contemporary Spine Surgery

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Adoption of awake spine surgery – trends from a national registry over 14 years

Cited by 11 publications

References 25 publications

Uniportal, Transforaminal Endoscopic Thoracic Discectomy: Review and Technical Note

Uniportal, Transforaminal Endoscopic Thoracic Discectomy: Review and Technical Note

General Versus Nongeneral Anesthesia for Spinal Surgery: A Comparative National Analysis of Reimbursement Trends Over 10 Years

The Role of Immersive Virtual Reality on the Patient Experience and Future Applications in Spinal Care

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