General vs. Non General Anesthesia for Lumbar Spine Surgeries in Octogenarians: A Comparative National Analysis of Reimbursement Trends.

Introduction: Non-GA spine surgeries are increasingly preferred due to advantages like quicker postoperative recovery, lower costs, and reduced complication rates. This research aims to analyze trends in physician reimbursements in the United States for spine surgeries under GA versus non-GA, specifically focusing on the octogenarian population.

Methods: We conducted a search in the ACS-NSQIP database to identify cases of GA and non-GA (including regional anesthesia, epidural anesthesia, spinal anesthesia, and anesthesia care with intravenous sedation) for spine procedures performed between the years 2012 and 2020 on octogenarians. The work relative value units per operating hour (wRVUs/h) were obtained for the decompression or stabilization procedures performed on the lumbar spine. Propensity score matching (1:1) was performed.

Results: We included 16480 patients in the study. GA was used in 16383 patients, while 97 operations were non-GA. After matching, there were 88 patients in total, equally divided between GA and non-GA. After matching, inpatients were higher in the GA group, compared to the awake group, while patients entering through the outpatient group had more non-GA (p=0.011). Non-GA surgeries were shorter compared to GA, in octogenarians (p < 0.01).
Trend analysis showed an increasing percentage of patients undergoing lumbar laminectomy under GA (p=0.047) and non-GA (p=0.008), with a higher slope for non-GA. The same trend is seen in lumbar fusions. In the trend analysis for wRVU/h in all lumbar surgeries, no trend was identified. However, an observable increase is seen in the non-GA group after 2017. There is no trend in wRVU/h for lumbar laminectomies, however there was an increase in the wRVU/h in the non-GA group for lumbar fusions (p=0.021), with no trend for GA.

Conclusion : The results indicate a gradual transition away from GA in some lumbar procedures performed on octogenarians. This may be attributed to advantages associated with non-GA, such as shorter surgical length and improved postoperative recovery. The economic ramifications, as evidenced by the changes in wRVU/h, also suggest an increasing efficiency and probable inclination towards non-GA treatments in specific categories of lumbar surgeries such as lumbar fusion.