title: Cost Analysis of Spinal Versus General Anesthesia for Lumbar Diskectomy and Laminectomy Spine Surgery.
abstract: BACKGROUND
  Lumbar spine surgery can be performed using various anesthetic modalities, most notably general or spinal anesthesia. Because data comparing the cost of these anesthetic modalities in spine surgery are scarce, this study asks whether spinal anesthesia is less costly than general anesthesia.
  
  
  METHODS
  A total of 542 patients who underwent elective lumbar diskectomy or laminectomy spine surgery between 2007 and 2011 were retrospectively identified, with 364 having received spinal anesthesia and 178 having received general anesthesia. Mean direct operating cost, indirect cost (general support staff, insurance, taxes, floor space, facility, and administrative costs), and total cost were compared among patients who received general and spinal anesthesia. Linear multiple regression analysis was used to identify the effect of anesthesia type on cost and determine the factors underlying this effect, while controlling for patient and procedure characteristics.
  
  
  RESULTS
  When controlling for patient and procedure characteristics, use of spinal anesthesia was associated with a 41.1% lower direct operating cost (-$3629 ± $343, P < 0.001), 36.6% lower indirect cost (-$1603 ± $168, P < 0.001), and 39.6% lower total cost (-$5232 ± $482, P < 0.001) compared with general anesthesia. Shorter hospital stay, shorter duration of anesthesia, shorter duration of operation, and lower estimated blood loss contributed to lower costs for spinal anesthesia, but other factors beyond these were also responsible for lower direct operating and total costs.
  
  
  CONCLUSIONS
  When comparing the benefits of spinal and general anesthesia, spinal anesthesia is less costly when used in patients undergoing lumbar diskectomy and laminectomy spine surgery.
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: prateek.agarwal@uphs.upenn.edu.
authors.forename: Prateek
authors.initials: P
authors.lastname: Agarwal
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: John
authors.initials: J
authors.lastname: Pierce
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Welch
mesh_terms: D000768:Anesthesia, General / Q000191:economics* / Q000706:statistics & numerical data; D000775:Anesthesia, Spinal / Q000191:economics* / Q000706:statistics & numerical data; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D017586:Diskectomy / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007796:Laminectomy / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016014:Linear Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies
keywords: Cost analysis; Diskectomy; General anesthesia; Laminectomy; Lumbar spine surgery; Operating cost; PACU; Postanesthesia care unit; Spinal anesthesia