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Spinal versus General Anesthesia: Comparing Outcomes in Pediatric Patients Undergoing Urologic Procedures
Nicole F. Ambrose, DO1, Kesavan Sadacharam, MD2, Brian Burke, MPH, MSF2, Ernesto Figueroa, MD2, Scott Lang, MD2, Stephanie Kjelstrom, MPH, CPH3, Jennifer Hagerty, DO2.
1Main Line Health, Bryn Mawr, PA, USA, 2Nemours Children's Health, Wilmington, DE, USA, 3Main Line Health, Wynnewood, PA, USA.

AbstractSpinal versus General Anesthesia: Comparing Outcomes in Pediatric Patients Undergoing Urologic Procedures
BACKGROUND: Available literature comparing spinal anesthesia (SA) to general anesthesia (GA) in the pediatric population describes multiple benefits in appropriately selected patients including cost reduction, lower incidence of complications, and shorter operative times. In patients undergoing urologic procedures, data is sparse. Our goal was to expand on the paucity of existing urologic literature as SA appears to be uniquely suited for a substantial number of its common pediatric procedures.METHODS: Within a single institution, patients who had a urologic procedure performed under SA between May 2019 and July 2021 and were less than 18 months old were studied and compared to a matched cohort of patients who had GA for similar procedures. SA and GA groups were compared by two sample t tests, chi square test for independence, and Fisher's exact test. A liner regression analysis was used for cost comparison. RESULTS: There were a total of 184 SA and 202 GA patients. There was no significant difference in the demographics except that SA patients were significantly younger and weighed less than GA patients (194.6 days vs 322 days, p <.0001; 7.6 kg vs 9.4 kg, p<.0001). The patients in the SA group needed significantly less opioids both during the surgery (26.1% vs 0% P N/A) and in the immediate post operative period in comparison to GA patients (18.2% vs 0% P N/A). The patients who had SA had significantly less complications such as bronchospasm requiring treatment with epinephrine and cardiovascular complications needing admission to PICU or cancellation of surgery (0% vs 6.8 % P =0.03). Total anesthesia time and emergence time were significantly lower for SA patients (50.2 vs 41 P= 0.001 & 6.1 vs 3.4 P=0.001). Both surgery time and total OR time were not significantly different between the two groups (37.6 vs 35.5 P 0.35 & 56.3 vs 54.4 P= 0.49). Overall raw material cost was also found to be lower per procedure in the SA group vs GA group ($8.90 vs $38.8; 77% reduction). Adjusted total mean costs for the surgery were not different between groups. The reduction in opioid use postoperatively also suggests reduced cost in the management of postoperative pain in the SA group.
CONCLUSIONS: Total anesthesia time, opioid use, and serious complications were all significantly lower in the SA group. We didn't find significant difference in total surgery cost between two groups. However, patients who had spinal anesthesia needed less rescue analgesics in the post operative period. The significant reduction in opioid use postoperatively also suggests reduced cost in the management of postoperative pain in the SA group. Therefore, SA was found to be a significantly safer and more cost-efficient alternative to GA while being equally effective and appropriate for many common pediatric urologic procedures.


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