Defining the Time Benefit of Awake Versus General Anesthesia for Single-Level Lumbar Spine Surgery

BACKGROUND: Awake anesthesia with monitored anesthesia care (MAC) might confer time benefits compared with traditional general anesthesia (GA) in the setting of single-level lumbar spine surgery. Therefore, we sought to define the quantitative time difference spent in the operating room between the MAC and GA approaches for single-level lumbar spine surgery. METHODS: A prospectively maintained database of the senior surgeon was reviewed for single-level lumbar spine surgeries from 2019 to 2020 performed with the patient under either GA or MAC. The patient demographics, clinical features, time in the operating room, and postoperative outcomes were all summarized and statistically compared. RESULTS: A total of 53 patients satisfied all the selection criteria, with 25 (47%) in the GA group and 28 (53%) in the MAC group. Overall, most patients were men, with a median age of 60 years. The 2 groups were statistically comparable with respect to the demographics and preoperative anesthesia parameters. The time from room arrival to sedation start (median time, 26 vs. 38 minutes; P < 0.01), sedation time (median time, 55 vs. 87 minutes; P < 0.01), and time from sedation end to room exit (median time, 4 vs. 13 minutes; P< 0.01) were all significantly shorter for the MAC group. Additionally, the estimated blood loss was less in the MAC group (P < 0.01). CONCLUSIONS: We found MAC to be a safe anesthesia option for use in single-level lumbar spine surgery, which led to statistically significant benefits regarding the time under sedation and time in the operating room compared with GA. Future studies are required to understand whether MAC will require other synergistic measures to generate observable change at a health systems level.