Costing Analysis of Awake Spinal Laminectomy versus Non-awake Spinal Laminectomy

Introduction: The use of regional anesthesia for minimally invasive lumbar spinal surgery has gained interest as a method to mitigate the risks associated with general anesthesia, particularly in patients with cardio-pulmonary comorbidities. However, the cost implications of this technique compared to traditional spinal laminectomy under general anesthesia remain unexplored. This study aims to compare the operative and total admission costs of awake spinal lumbar laminectomy with those of standard spinal lumbar laminectomy performed under general anesthesia

Methods: Our study included patients undergoing single-level laminectomy at the L3-L4 or L4-L5 vertebral levels using an awake spinal anesthesia protocol. Candidates for the awake procedure were pre-screened for psychological suitability, focusing on anxiety and claustrophobia levels. We evaluated direct operating room costs, total admission costs, and perioperative outcomes including in-room time, procedural duration, blood loss, and length of stay (LOS). Data were analyzed using t-tests, comparing 1-level L3-L4 or L4-L5 laminectomy patients under general anesthesia.

Results: Nine awake and eight non-awake patients were compared. Charlson Comorbidity Index scores were similar (awake: 5.67 ± 2.39; non-awake: 3.63 ± 2.66). No conversions to general anesthesia or intraoperative complications occurred. Awake procedures had shorter procedural times (50.89 ± 15 min vs. 78.75 ± 11.4 min; p < 0.001). LOS was slightly shorter for awake surgeries (30.8 ± 27.6 hours vs. 42.5 ± 37.2 hours). Costs were comparable: awake surgeries averaged $8,622.45 ± $1,480 in OR costs and $12,389.97 ± $6,271 in total, while non-awake surgeries cost $8,949.62 ± $1,442.47 in the OR and $12,091 ± $4,571 in total. None of these differences were statistically significant.

Conclusion : Awake and non-awake single-level laminectomy procedures present similar cost profiles during hospital admission. Differences were observed in procedural time but not in operative cost, suggesting that potential financial benefits of awake spinal surgery may lie in the prevention of cardio-pulmonary complications rather than direct surgical cost savings.