5 trends in awake spine surgery over 14 years


Awake spine surgery has gained traction in recent years with several key trends emerging in patient outcomes and adoption, according to an analysis published in the October 2022 edition of The Spine Journal.

Researchers analyzed 301,521 cervical or lumbar spine surgery patients from the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2019. Patients were categorized as having general anesthesia (294,903 patients) or awake surgery (6,618 patients).

Five findings:

1. The proportion of awake spine cases increased from nearly 0 percent in 2005 to 2.1 percent in 2019.

2. The uptick in awake spine surgery was "statistically significant" in cervical and lumbar operations between 2005 and 2019. Cervical cases rose from 0 percent to 1.1 percent, and lumbar cases grew from 0 percent to 2.9 percent.

3. Thirty-day complication rates, readmission rates and mean length of stay decreased between 2007 and 2019 in awake lumbar spine patients. Complication rates fell from 19.1 percent to 5.4 percent; readmission rates fell from 5.9 percent to 2.8 percent; and mean length of stay fell from an average 30.9 hours to 24.9 hours.

4. Awake cervical spine patients saw similar 30-day outcomes. Complication rates fell from 20.1 percent to 6.1 percent; readmission rates fell from 6.7 percent to 3.7 percent; and mean length of stay fell from an average 27 hours to 20 hours.

5. While trends show growing utilization and improved outcomes in awake spine surgery, the proportion of awake cases remains low, researchers concluded. More research is needed to study the barriers to widespread adoption, the authors wrote.

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