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Comparative effectiveness of anesthetic technique on outcomes after lumbar spine surgery: a retrospective propensity score-matched analysis of the National Surgical Quality Improvement Program, 2009–2019
  1. Krizia Amoroso1,
  2. Ichiro Okano2,
  3. Michele Sarin1,
  4. Alexander P Hughes2,
  5. William D Zelenty2,
  6. Jennifer Shue2,
  7. Andrew A Sama2,
  8. Frank P Cammisa2,
  9. Federico P Girardi2 and
  10. Ellen M Soffin3
  1. 1Hospital for Special Surgery, New York, New York, USA
  2. 2Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
  3. 3Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
  1. Correspondence to Dr Ellen M Soffin, Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY 10021, USA; soffine{at}


Background The impact of anesthetic technique on spine surgery outcomes is controversial. Using a large national sample of patients, we compared outcomes after lumbar decompression under regional anesthesia (RA: spinal or epidural) or general anesthesia (GA).

Methods A retrospective population-based study of American College of Surgeons National Surgical Quality Improvement Program data (2009–2019). Patients were propensity score (PS) matched 3:1 (GA:RA) on demographic and surgical variables. The primary outcome was the association between anesthetic type and any complication (cardiac, pulmonary, renal, transfusion, stroke, infectious, deep vein thrombosis/pulmonary embolus). Secondary outcomes included the association between anesthetic type and individual complications, readmission and length of stay (LOS). Unadjusted comparisons (OR, 95% CI), logistic regression and adjusted generalized linear modeling (parameter estimate, PE, 95% CI) were performed before and after PS matching.

Results Of 1 51 010 cases, 149 996 (99.3%) were performed under GA, and 1014 (0.67%) under RA. After matching, 3042 patients with GA were compared with 1014 patients with RA. On unadjusted analyses, RA was associated with lower odds of complications (OR 0.43, 0.3 to 0.6, p<0.001), shorter LOS (RA: 1.1±3.8 days vs GA: 1.3±3.0 days; p<0.001) and fewer blood transfusions (RA: 3/1014, 0.3% vs GA: 40/3042, 1.3%; p=0.004). In adjusted analyses, RA was associated with fewer complications (PE −0.43, –0.81 to −0.06, p=0.02) and shorter LOS (PE −0.76, –0.90 to −0.63, p<0.001). There was no significant association between anesthetic type and readmission (PE −0.34, –0.74 to 0.05, p=0.09).

Conclusions Compared with GA, RA was associated with fewer complications, less blood transfusion and shorter LOS after spine surgery. Although statistically significant, the magnitude of effects was small and requires further prospective study.

  • Postoperative Complications

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors EMS and APH conceived the idea. All authors contributed to the design of the work. KA, JS, MS acquired the data. IO and MS analyzed the data. All authors interpreted the data. EMS, KA, JS drafted the article. All authors revised the work critically for important intellectual content. All authors approved the version for publication. EMS acts as guarantor of the work, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.