Spinal versus general anesthesia for lumbar spine surgery in high risk patients: Perioperative hemodynamic stability, complications and costs

Finsterwald, Michael; Muster, Marco; Farshad, Mazda; Saporito, Andrea; Brada, Muriel; Aguirre, José

doi:10.1016/j.jclinane.2018.01.004

Cited by 66 publications

(54 citation statements)

References 33 publications

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“…The second study of SA for spine surgery in the geriatric population compared outcomes of lumbar decompression in 146 SA patients to those in 292 GA patients. 16 The SA group was selected based on high cardiovascular and/or pulmonary risk (American Society of Anesthesiologists [ASA] II-IV). There was no ASA cutoff for the GA group.…”

Section: Discussionmentioning

confidence: 99%

Spinal Anesthesia for Geriatric Lumbar Spine Surgery: A Comparative Case Series

et al. 2020

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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 ¼ .002), consisted of more men (57% versus 36%, P ¼ .01), and had a lower mean body mass index (28.3 versus 30.1, P ¼ .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 ¼ .71). After controlling for age, sex, and body mass index, patients receiving SA had decreased estimated blood loss (b ¼ À75 mL; 95% confidence interval [CI], À140.6, À9.4; P ¼ .025) and intraoperative intravenous fluid requirements (b ¼À205 mL; 95% CI, À389.4, À21.0; P ¼ .029), shorter postanesthesia care unit stays (b ¼À41 minutes; 95% CI, À64.6, À16.9; P ¼ .001), lower maximum visual analog scale pain scores (b ¼À0.89 points; 95% CI, À1.6, À0.1; P ¼ .020), and decreased odds of receiving blood transfusion (odds ratio, 0.12; 95% CI, 0.01, 0.62; P ¼ .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. Lumbar Spine PATIENTS AND METHODS With Institutional Review Board approval, we retrospectively identified a consecutive series of patients from a prospectively collected database

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Section: Discussionmentioning

confidence: 99%

Spinal Anesthesia for Geriatric Lumbar Spine Surgery: A Comparative Case Series

et al. 2020

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“…Whatever the true number, the mortality differential between spinal and general is almost certainly declining as a result of increased knowledge of the physiology of spinal anesthesia, together with the use of less toxic local anesthetics and improved monitoring during spinal anesthesia (Patil et al 2019;Finsterwald et al 2018).…”

Section: Spinal Anesthesia Fatalitiesmentioning

confidence: 99%

Perioperative and anesthetic deaths: toxicological and medico legal aspects

Argo

Zerbo

Lanzarone

et al. 2019

Egypt J Forensic Sci

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Background: Anesthesia has become safer during decades, though there is still a preventable mortality; the complexity of medical and surgical interventions, increasingly older and sicker patients, has created a host of new hazards in anesthesiology. In this paper, some of these perioperative (PO) fatal adverse events are investigated in terms of health responsibility. Selective literature research in several data bases, concerning perioperative and anesthetic deaths and medical responsibility, was performed. Main text: A generally accepted definition of the anesthesia and perioperatory-related death still remains one of the major concerns in forensic pathology, and the terms "operative deaths" and "anesthetic deaths" are usually applied inaccurately within the medico-legal literature. Such events involve comprehensively PO fatalities and allow for subtle separation of natural and unnatural death, at least from the prospective of forensic pathology. Iatrogenic deaths in this field can be separated into some major categories, as attributable to previous patient's unfavorable conditions or depending from surgical procedure per se (such as PO cardiac and cerebrovascular events). In this review, the authors carried out syntheses of specific research areas regarding epidemiology, complications of general and spinal anesthetic, failure in airway management and patient's circulatory homeostasis, and adverse drugs reactions; analysis considering the challenge of anesthetic-related mortality, epidemiology and classifications, by indicating causal chain of death, in respect of both contributing and associated anesthetic and surgery facts. Conclusions: Perioperative quality control programs and its relevance for medico-legal evaluation are emphasized as, although mortality rates have decreased worldwide over the last decades, however, preventable drug-related deaths still happen. Such fatal events have to be considered within the field of forensic pathology experts, with regard of malpractice claims, to implement a strategy for preventing potentially fatal complications.

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“…Perhaps it was the natural evolution of the daily anesthesiologists’ practice from old habits to modern science. The advantage and cost effectiveness of regional anesthesia compared to the general one for operations of short duration in high risk patients are well documented [35, 36]. On the other hand, perhaps this change may relate to the reduced public health expenditures (including the hospital budgets) by 5.5 billion euros between 2009 and 2012 [37], a fact not leaving unaffected the financing of any public hospital’s Unit or Department.…”

Section: Discussionmentioning

confidence: 99%

Emergency inguinal hernioplasties in a tertiary public Hospital in Athens Greece, during the economic crisis

et al. 2019

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BackgroundAlthough the effect of the recent Greek economic crisis and austerity on the population’s health and the health system effectiveness have been discussed a lot recently, data on common surgical conditions affecting large part of the population are missing. Using inguinal hernia as a model we investigated possible changes of citizens’ attitude regarding the time of referral, the perioperative details and the intraoperative findings of the emergency hernioplasties.MethodsThe present retrospective study was conducted by a Department of Surgery in a tertiary public hospital of the Greek capital. We reviewed the records of all hernioplasties performed during two 5-year periods: 2005–2009 and 2012–2016, i.e. before and during the crisis focusing on the emergency ones (either incarcerated or strangulated).ResultsAn equal number of hernioplasties was performed in both periods. During the crisis however, an emergency hernioplasty was significantly more probable (HR 1.269, 95% CI 1.108–1.1454, p = 0.001), at a younger age (p = 0.04), mainly in patients younger than 75 years old (p = 0.0013). More patients presented with intestinal ischemia (7 vs 18, p = 0.002), requiring longer hospitalization (5.2 vs 9.6 days, p = 0.04), with higher cost (560 ± 262.4€ vs 2125 ± 1180.8€ p < 0.001). In contrast the percentage of patients with intestinal resection, their hospitalization length and treatment-cost remained unchanged. During the crisis there was a non-significant increase of emergency patients requiring ICU postoperatively (0 vs 4, p = 0.07) and a non-significant 60% increase of emergency operations in migrants/refugees population (3.5% vs 5.8%, p = 0.28). Epidural anesthesia was significantly more frequent during the crisis.ConclusionDuring the crisis: (i) the emergency hernioplasties increased significantly, (ii) more patients (exclusively Greek) presented with intestinal ischemia requiring longer hospitalization and higher treatment cost, (iii) the mean age of the urgently treated patients decreased significantly (iv) regional (epidural) anesthesia was more frequent. Although a direct causal relation could not be proven by the present study most observations can be explained by an increase of the patients who delayed the elective treatment of their hernia, and by a redistribution of the surgical workload towards big central hospitals. This can be prevented by adequately supporting the small district hospitals.

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Spinal versus general anesthesia for lumbar spine surgery in high risk patients: Perioperative hemodynamic stability, complications and costs

Cited by 66 publications

References 33 publications

Spinal Anesthesia for Geriatric Lumbar Spine Surgery: A Comparative Case Series

Spinal Anesthesia for Geriatric Lumbar Spine Surgery: A Comparative Case Series

Perioperative and anesthetic deaths: toxicological and medico legal aspects

Emergency inguinal hernioplasties in a tertiary public Hospital in Athens Greece, during the economic crisis

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