Awake Spinal Anesthesia Results in Lower Costs Compared to General Anesthesia in Transforaminal Lumbar Interbody: A Retrospective Analysis

Introduction: Awake spine surgery via spinal anesthesia (SA) has emerged as a viable alternative to general anesthesia (GA) in transforaminal lumbar interbody fusions (TLIF). This study aims to evaluate the cost-effectiveness of SA compared to GA for TLIF at a single academic institution.

Methods: A retrospective review of 19 patients who underwent TLIF between January 2018 and December 2022 was conducted. Patients in the SA cohort were compared to demographically matched counterparts in the GA cohort. Welch’s t-test and chi-squared tests were used for statistical comparisons.

Results: Patients in the SA cohort (n=9, mean age 65.8±6.8 years) were compared to the GA cohort (n=10, mean age 67.2±7.5 years). Lower total cost was observed in the SA cohort than in the GA group (mean difference: -$7450.24, p=0.056). Both groups had comparable comorbidities (smoking, hypertension, diabetes, prior spine surgery) and clinical outcomes. OR Supply costs were significantly lower in the SA group (mean difference: -$3426.33, p=0.036). Sub-analysis indicated Sedatives and Anesthetics costs were significantly lower within the SA cohort (mean difference: -$118.48, p=0.001). Although total in-patient costs did not differ significantly, the SA group had lower Labs and Blood Tests (mean difference: -$90.93, p=0.033), Imaging and Diagnostic Tests (mean difference: -$19.65, p=0.017), Evaluation and Therapy (mean difference: -$256.04, p=0.028), and Medications (mean difference: -$36.57, p=0.031).

Conclusion : Awake TLIF using spinal anesthesia may be a cost-effective alternative to general anesthesia, significantly reducing costs without compromising clinical outcomes. These findings suggest awake techniques should be considered to optimize resource use and improve surgical efficiency. Future research should replicate this in a larger sample and assess indirect costs to the patient.