344 Comparative Outcomes of Awake Spine Surgery Under Spinal vs. General Anesthesia: A Comprehensive Systematic Review and Meta-Analysis

INTRODUCTION: Awake surgery, under spinal anesthesia (SA), is an alternative to surgery under general anesthesia (GA), in neurological and spine surgery. In the literature, there seem to be some evidence supporting benefits associated with the use of this anesthetic modality, as compared to GA. Currently, there is a notable lack of updated and comprehensive review addressing the complications associated with both awake SA and GA in spine surgery. METHODS: A systematic search was conducted to identify studies that assessed SA in spine surgery from database inception to April 14, 2023, in PubMed, Medline, Embase, and Cochrane databases. Outcomes of interest included estimated blood loss, length of hospital stay, operative time, and overall complications. Meta-analysis was conducted using random effects models. RESULTS: In total, 38 studies that assessed 7,820 patients were included. Awake patients had significantly shorter lengths of hospital stay (Mean difference (MD): -0.40 days; 95% CI, -0.64 - -0.17) and operative time (MD: -19.17 min; 95% CI, -29.68 - -8.65) compared to patients under GA. The overall complication rate was significantly higher in patients under GA than SA (RR, 0.59 [95% CI, 0.47-0.74]). Patients under GA had significantly higher rates of postoperative nausea/vomiting RR, 0.60 [95% CI, 0.39-0.90]) and urinary retention (RR, 0.61 [95% CI, 0.37-0.99]). CONCLUSIONS: Patients undergoing awake spine surgery under SA had significantly shorter operations and hospital stays, and fewer rates of postoperative nausea and urinary retention as compared to GA. In summary, awake spine surgery offers a valid alternative to GA and added benefits in terms of postsurgical complications, while being associated with relatively low morbidity.