An Analysis of the Cost-Effectiveness of Spinal Versus General Anesthesia for Lumbar Spine Surgery in Various Hospital Settings

Abstract

Study Design: Retrospective chart review. Objective: To determine the relative cost-effectiveness of spinal anesthesia and general anesthesia for lumbar laminectomy and microdiscectomy surgery performed in an academic versus private practice hospital setting. Methods: The authors retrospectively reviewed charts of 188 consecutive patients who underwent lumbar laminectomy or microdiscectomy by a single surgeon from 2012 to 2016 at either an academic or a private practice hospital setting. Intraoperative and postoperative outcomes were recorded and direct variable costs were calculated. Results: At the academic institution, the direct cost of a lumbar laminectomy or microdiscectomy surgery under general anesthesia was determined to be 9.93% greater than with spinal anesthesia ( P = .040). The greatest difference was seen with operating room costs, in which general anesthesia was associated with 18.74% greater costs than spinal anesthesia ( P = .016). There was no significant difference in cost at the private practice hospital setting. Conclusions: We conclude that use of spinal anesthesia for lumbar laminectomy leads to less operating room, postanesthesia care unit, and anesthesia times, lower levels of postoperative pain, and no increased rate of other complications compared with general anesthesia at an academic institution as compared to a private practice setting. Spinal anesthesia is 9.93% less expensive than general anesthesia, indicating substantial cost-saving potential. With no sacrifice of patient outcomes and the added benefit of less pain and recovery time, Spinal anesthesia represents a more cost-effective alternative to general anesthesia in lumbar spine surgery in the academic hospital setting.

Lumbar spine instrumented fusion surgery under spinal anaesthesia versus general anaesthesia-A retrospective study of 239 cases

“…Mathew et al 16 found less expenditure in SA for a similar lumbar spine surgery under GA and we had the same experience of overall 10% cost saving in SA group.…”

“…Spinal anaesthesia for lumbar spine instrumented fusion surgeries leads to less anaesthesia procedure time, overall operating room, PACU time. 16,17 The cost of consumables and medicines used in SA is less than in case of GA. We have seen from the overall expenditure that in case of SA there is average 10% of cost reduction. Without compromising the outcome SA is clearly most cost effective alternative to GA in lumbar spine instrumented surgeries.…”

Factors Determining the Choice of Spinal Versus General Anesthesia in Patients Undergoing Ambulatory Surgery: Results of a Multicenter Observational Study

“…In addition, spinal anesthesia is considered to be less cost-effective for some procedures, such as inguinal hernia repair [13] or lumbar spine surgery [14]. There is no morbidity or mortality evidence in favor of either spinal anesthesia or general anesthesia [15].…”

Microendoscopic lumbar discectomy with general versus local anesthesia: A systematic review and meta-analysis

“…Prior studies have suggested that anesthetic technique may impact surgical outcomes due to the known associated complications and side-effects of general anesthesia [ 11 , 12 , 22 , 27 ]. Additionally, it is possible that anesthetic technique may influence a surgeon's decision-making intraoperatively due to the added factor of patient discomfort that must be considered in awake spinal surgery.…”