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Awake Spinal Fusion Is Associated with Reduced Length of Stay, Opioid Use, and Time to Ambulation Compared to General Anesthesia: A Matched Cohort Study.

Publication ,  Journal Article
Sykes, DAW; Tabarestani, TQ; Chaudhry, NS; Salven, DS; Shaffrey, CI; Bullock, WM; Guinn, NR; Gadsden, J; Berger, M; Abd-El-Barr, MM
Published in: World Neurosurg
August 2023

OBJECTIVE: There is increasing interest in performing awake spinal fusion under spinal anesthesia (SA). Evidence supporting SA has been positive, albeit limited. The authors set out to investigate the effects of SA versus general anesthesia (GA) for spinal fusion procedures on length of stay (LOS), opioid use, time to ambulation (TTA), and procedure duration. METHODS: The authors performed a retrospective review of a single surgeon's patients who underwent lumbar fusions under SA versus GA from June of 2020 to June of 2022. SA patients were compared to demographically matched GA counterparts undergoing comparable procedures. Analyzed outcomes include operative time, opioid usage in morphine milligram equivalents, TTA, and LOS. RESULTS: Ten SA patients were matched to 10 GA counterparts. The cohort had a mean age of 66.77, a mean body mass index of 27.73 kg/m2, and a median American Society of Anesthesiologists Physical Status Score of 3.00. LOS was lower in SA versus GA patients (12.87 vs. 50.79 hours, P = 0.001). Opioid utilization was reduced in SA versus GA patients (10.76 vs. 31.43 morphine milligram equivalents, P = 0.006). TTA was reduced in SA versus GA patients (7.22 vs. 29.87 hours, P = 0.022). Procedure duration was not significantly reduced in SA patients compared to GA patients (139.3 vs. 188.2 minutes, P = 0.089). CONCLUSIONS: These preliminary retrospective results suggest the use of SA rather than GA for lumbar fusions is associated with reduced hospital LOS, reduced opioid utilization, and reduced TTA. Future randomized prospective studies are warranted to determine if SA usage truly leads to these beneficial outcomes.

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Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

August 2023

Volume

176

Start / End Page

e91 / e100

Location

United States

Related Subject Headings

  • Walking
  • Wakefulness
  • Spinal Fusion
  • Retrospective Studies
  • Morphine Derivatives
  • Length of Stay
  • Humans
  • Cohort Studies
  • Anesthesia, Spinal
  • Anesthesia, General
 

Citation

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Sykes, D. A. W., Tabarestani, T. Q., Chaudhry, N. S., Salven, D. S., Shaffrey, C. I., Bullock, W. M., … Abd-El-Barr, M. M. (2023). Awake Spinal Fusion Is Associated with Reduced Length of Stay, Opioid Use, and Time to Ambulation Compared to General Anesthesia: A Matched Cohort Study. World Neurosurg, 176, e91–e100. https://doi.org/10.1016/j.wneu.2023.05.001
Sykes, David A. W., Troy Q. Tabarestani, Nauman S. Chaudhry, David S. Salven, Christopher I. Shaffrey, W Michael Bullock, Nicole R. Guinn, Jeffrey Gadsden, Miles Berger, and Muhammad M. Abd-El-Barr. “Awake Spinal Fusion Is Associated with Reduced Length of Stay, Opioid Use, and Time to Ambulation Compared to General Anesthesia: A Matched Cohort Study.World Neurosurg 176 (August 2023): e91–100. https://doi.org/10.1016/j.wneu.2023.05.001.
Sykes DAW, Tabarestani TQ, Chaudhry NS, Salven DS, Shaffrey CI, Bullock WM, et al. Awake Spinal Fusion Is Associated with Reduced Length of Stay, Opioid Use, and Time to Ambulation Compared to General Anesthesia: A Matched Cohort Study. World Neurosurg. 2023 Aug;176:e91–100.
Sykes, David A. W., et al. “Awake Spinal Fusion Is Associated with Reduced Length of Stay, Opioid Use, and Time to Ambulation Compared to General Anesthesia: A Matched Cohort Study.World Neurosurg, vol. 176, Aug. 2023, pp. e91–100. Pubmed, doi:10.1016/j.wneu.2023.05.001.
Sykes DAW, Tabarestani TQ, Chaudhry NS, Salven DS, Shaffrey CI, Bullock WM, Guinn NR, Gadsden J, Berger M, Abd-El-Barr MM. Awake Spinal Fusion Is Associated with Reduced Length of Stay, Opioid Use, and Time to Ambulation Compared to General Anesthesia: A Matched Cohort Study. World Neurosurg. 2023 Aug;176:e91–e100.
Journal cover image

Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

August 2023

Volume

176

Start / End Page

e91 / e100

Location

United States

Related Subject Headings

  • Walking
  • Wakefulness
  • Spinal Fusion
  • Retrospective Studies
  • Morphine Derivatives
  • Length of Stay
  • Humans
  • Cohort Studies
  • Anesthesia, Spinal
  • Anesthesia, General