General Versus Non General Anesthesia for Endoscopic Spine Decompression: A Retrospective Multicenter Registry-Based Study

Introduction: Endoscopic spine decompression represents a minimally invasive approach that offers the potential for reduced recovery times and postoperative complications. The choice of anesthesia—general anesthesia (GA) versus non-general anesthesia (non-GA)—is critical in influencing patient outcomes, hospital stay duration, and overall recovery. This study aims to evaluate the differences in clinical outcomes between GA and non-GA in patients undergoing endoscopic spine decompression.

Methods: The National Surgical Quality Improvement Project database was queried for patients undergoing Endoscopic lumbar spine decompression between 2017 and 2022. Surgical outcomes, morbidity, mortality, LOS, and 30-day postoperative complications were compared between the two anesthesia methods after 2:1 propensity score matching.

Results: A total of 336 patients (299 in the GA and 37 in the non-GA group) were included.
The analysis of patient demographics and characteristics reveals no significant differences in sex, race distribution, or BMI between those receiving GA and non-GA. Neither group required postoperative ventilation. However, the proportion of non-GA patients with Chronic Obstructive Pulmonary Disease (COPD) was significantly higher (16.2% vs. 3.3%, p < 0.001). Furthermore, the non-GA group had significantly shorter hospital stays on average (0.027 days vs. 1.060 days, p = 0.001) while being older (mean age of 66 vs. 53 years, p < 0.001). Complications were similar between groups, and no notable differences in mortality or morbidity probabilities were found, though there was a trend toward lower morbidity in the non-GA group. In a matched comparison designed to control for confounding variables, the total length of stay was notably shorter for the non-GA group (p=0.002). Morbidity and mortality probabilities were also significantly lower in the non-GA group (p=0.006 for both). There was a non-significant trend towards higher readmission rates in the GA group as well.

Conclusion : In this retrospective cohort study evaluating endoscopic spine surgery, the use of non-GA was associated with better short-term outcomes when compared with GA, including significantly shorter hospital stays and lower morbidity rates. The findings suggest that non-GA is a safe alternative for endoscopic spine surgery and its application in minimally invasive spine procedures, could potentially lead to enhanced recovery protocols and optimized patient care.