Our Summary

This research paper investigates the growing trend of non-general anesthesia (non-GA) in spine surgeries, which has been observed to lead to quicker post-surgery recovery, lower costs, and fewer complications compared to surgeries performed under general anesthesia (GA). The study aims to compare the payment doctors receive for performing these two types of surgeries.

The researchers looked at data from spine surgeries conducted between 2011-2020, where GA and non-GA (such as regional, epidural, spinal, and intravenous sedation) were used. They specifically looked at how much work (measured in work relative value units, or wRVUs) was involved per hour of surgery for different types of spine surgeries.

The study included data from over 474,000 patients who underwent spine surgery. The vast majority of these surgeries (over 472,000) were performed under GA, while around 2,500 were non-GA. The researchers found that the number of non-GA surgeries significantly increased over the study period. They also found that non-GA surgeries took less time and resulted in shorter hospital stays.

Interestingly, for lumbar (lower back) surgeries, doctors were paid more per hour of work for non-GA procedures compared to GA ones. This was not the case for surgeries on the cervical (neck) or thoracic (mid-back) spine. Additionally, the payment per hour of work for lumbar surgeries performed under non-GA increased yearly, while it remained stable for GA surgeries.

In conclusion, the study found that non-GA surgeries on the lower back are associated with higher and increasing payments to doctors compared to those performed under GA. The payments for neck and mid-back surgeries were the same regardless of the type of anesthesia used. The use of non-GA in spine surgeries significantly increased over the study period.

FAQs

  1. What are the benefits of non-general anesthesia in spine surgeries according to the research?
  2. How did the payments differ for doctors performing lumbar surgeries under non-GA and GA procedures?
  3. Did the use of non-general anesthesia in spine surgeries increase or decrease over the study period according to the research?

Doctor’s Tip

One helpful tip a doctor might tell a patient about spinal surgery is to carefully follow post-operative instructions provided by the medical team. This can include proper wound care, medication management, physical therapy exercises, and restrictions on activities to promote healing and prevent complications. It is important for patients to communicate any concerns or changes in symptoms to their healthcare provider to ensure a successful recovery.

Suitable For

The types of patients typically recommended for spinal surgery vary depending on the specific condition being addressed. Some common reasons for spinal surgery include:

  1. Degenerative disc disease: Patients with degenerative disc disease may be recommended for spinal surgery if conservative treatments have not been effective in managing their symptoms, such as chronic back pain or radiating leg pain.

  2. Herniated disc: Patients with a herniated disc, also known as a slipped or bulging disc, may undergo spinal surgery if the disc is pressing on a nerve and causing symptoms such as pain, numbness, or weakness in the arms or legs.

  3. Spinal stenosis: Spinal stenosis is a condition where the spinal canal narrows and puts pressure on the spinal cord or nerves. Patients with severe spinal stenosis may require surgery to relieve the pressure and alleviate symptoms such as pain, numbness, or weakness.

  4. Scoliosis: Scoliosis is a curvature of the spine that can cause pain, discomfort, and difficulty breathing in severe cases. Patients with severe scoliosis may be recommended for spinal surgery to correct the curvature and improve spinal alignment.

  5. Spinal fractures: Patients with spinal fractures, such as those caused by trauma or osteoporosis, may require surgery to stabilize the spine, relieve pain, and prevent further damage to the spinal cord or nerves.

  6. Tumors: Patients with spinal tumors, whether cancerous or non-cancerous, may undergo spinal surgery to remove the tumor, relieve pressure on the spinal cord or nerves, and improve quality of life.

Overall, the decision to recommend spinal surgery for a patient is based on a thorough evaluation of their specific condition, symptoms, medical history, and overall health. It is important for patients to discuss their treatment options with a spine specialist to determine the most appropriate course of action for their individual needs.

Timeline

Overall, the timeline for a patient before and after spinal surgery typically involves:

  1. Pre-surgery consultation and evaluation by a spine specialist to determine the best course of treatment.
  2. Pre-operative preparation, including tests, imaging scans, and possibly physical therapy to optimize the patient’s condition before surgery.
  3. The day of surgery, where the patient will undergo anesthesia and the spine surgery procedure.
  4. Post-operative recovery in the hospital, where the patient will be monitored for any complications and receive pain management.
  5. Discharge from the hospital and transition to at-home recovery, which may involve physical therapy, pain management, and follow-up appointments with the surgeon.
  6. Follow-up appointments with the surgeon to assess the patient’s progress and make any necessary adjustments to the treatment plan.

After spinal surgery, patients can expect a period of rehabilitation and physical therapy to help regain strength and mobility in the affected area. The length and intensity of this rehabilitation will vary depending on the type of surgery performed and the individual patient’s condition. It is important for patients to follow their surgeon’s recommendations for post-operative care to ensure a successful recovery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about spinal surgery include:

  1. What are the risks and benefits of using non-general anesthesia for my specific spine surgery?
  2. How does non-general anesthesia compare to general anesthesia in terms of recovery time, costs, and potential complications?
  3. Will I have a choice in the type of anesthesia used for my surgery, or is it determined by the surgical team?
  4. How will the type of anesthesia used affect my post-operative pain management and overall comfort during and after the surgery?
  5. Are there any specific qualifications or training that the anesthesia provider should have when using non-general anesthesia for spine surgery?
  6. What are the potential side effects or complications associated with non-general anesthesia in spine surgery, and how are they managed?
  7. How does the use of non-general anesthesia impact the length of my hospital stay and overall recovery process?
  8. Can you provide me with information on the success rates and outcomes of spine surgeries performed under non-general anesthesia compared to general anesthesia?
  9. Are there any specific pre-operative or post-operative instructions I should follow if I choose to have my spine surgery under non-general anesthesia?
  10. How will the decision to use non-general anesthesia for my spine surgery affect the overall cost of the procedure and my insurance coverage?

Reference

Authors: Ghaith AK, Akinduro OO, El-Hajj VG, De Biase G, Ghanem M, Rajjoub R, Faisal UH, Saad H, Abdulrahim M, Bon Nieves A, Chen SG, Pirris SM, Bydon M, Abode-Iyamah K. Journal: Neurosurgery. 2024 Feb 1;94(2):413-422. doi: 10.1227/neu.0000000000002670. Epub 2023 Sep 14. PMID: 37856210