General Versus Non General Anesthesia for Spinal Surgery: A Comparative National Analysis of Reimbursement Trends Over 10 Years.

Wednesday, February 21, 2024

Presenting Author(s)

OA

Oluwaseun O. Akinduro, MD

Fellow
Mayo Clinic Florida
Providence, Rhode Island, United States

Co-Author(s)

Abdul Karim Ghaith, MD

Research Fellow- PhD candidate
Mayo clinic- rochester-mn
Rochester, MN, US
KA

Kingsley O. Abode-Iyamah, MD

Consultant
Mayo Clinic Florida, Department of Neurosurgery
Atlantic Beach, Florida, United States
AB

Antonio Bon Nieves, BS

Medical Student
Mayo Clinic
Dorado, PR, United States
Mohamad Bydon, MD

Professor of Neurosurgery
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
Rochester, MN, US
SC

Selby Chen, MD

Professor
Mayo Clinic Florida
Jacksonville, Florida, United States
Gaetano De Biase, MD

Resident
Mayo Clinic Florida
Jacksonville, Florida, United States
Victor El-Hajj, BS

Medical Student
Karolinska
Stockholm, SE
MG

Marc Ghanem, MD

Medical Student
Stanford, United States
SP

Stephen Pirris, MD

Professor
Mayo Clinic Florida
Jacksonville, Florida, United States
HS

Hassan Saad, MD

Resident
Emory, United States

Disclosure(s):

Abdul Karim Ghaith, MD: No financial relationships to disclose

Victor Gabriel El-Hajj, BS: No financial relationships to disclose

Introduction: Nongeneral anesthesia (non-GA) spine surgery is growing in popularity and has facilitated earlier post-operative recovery, reduced cost, and fewer complications compared with spine surgery under general anesthesia (GA). Changes in reimbursement policies have been demonstrated to correlate with clinical practice; however, they have yet to be studied for GA vs. non-GA spine procedures. We aimed to investigate trends in physician reimbursement for GA vs. non-GA spine surgery in the United States.

Methods: We queried the ACS-NSQIP for GA and non-GA (regional, epidural, spinal, and anesthesia care/intravenous sedation) spine surgeries from 2011 to 2020. Work relative value units per operative hour (wRVUs/h) were retrieved for decompression or stabilization of the cervical, thoracic, and lumbar spine. Propensity score matching (1:1) was performed using all baseline variables.

Results: We included 474,706 patients who underwent spine decompression or stabilization procedures. GA was used in 472 248 operations, whereas 2458 operations were non-GA. The proportion of non-GA spine operations significantly increased during the study period. Operative times (P < .001) and length of stays (P < .001) were shorter in non-GA when compared with GA procedures. Non-GA lumbar procedures had significantly higher wRVUs/h when compared with the same procedures performed under GA (decompression; P< .001 and stabilization; P= .039). However, the same could not be said about cervical thoracic procedures. Lumbar decompression surgeries using non-GA witnessed a significant yearly increase in wRVUs/h (P < .01) contrary to GA (P= .72). Physician reimbursement remained stable for procedures of the cervical or thoracic spine regardless of the anesthesia.

Conclusion : Non-GA lumbar decompressions and stabilizations are associated with higher and increasing reimbursement trends (wRVUs/h) than those under GA. Reimbursement for cervical and thoracic surgeries was equal regardless of the type of anesthesia and was relatively stable during the study period. Adopting a non-GA technique relative to the GA increased significantly during the study period.