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Comparing costs of awake vs general anesthesia in patients undergoing spine surgery: A systematic review and meta-analysis
Journal article   Open access   Peer reviewed

Comparing costs of awake vs general anesthesia in patients undergoing spine surgery: A systematic review and meta-analysis

Claudia Fernandez Perez, Carlos Aguilera, Jean Paul Bryant, Kingsley Owusu Otoo, Clare Grady, Alexis L. Price, M. Nathan Nair and Faheem A. Sandhu
Seminars in spine surgery, v 38(3), 101268
01 Oct 2026
DOI: https://doi.org/10.1016/j.semss.2026.101268
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url
https://doi.org/10.1016/j.semss.2026.101268View
Published, Version of Record (VoR) Open

Abstract

The costs associated with spine surgery represent a significant economic burden on healthcare systems. Awake anesthesia provides a potentially cost-effective alternative, but questions remain regarding its effectiveness in maintaining clinical outcomes when compared to general anesthesia. The purpose of this study was to determine if awake anesthesia reduced costs while maintaining clinical outcomes when compared to general anesthesia in patients undergoing spine surgery. A comprehensive literature search was conducted in PubMed, Web of Science, and the Cochrane Library through February 2026. Studies were included if they compared costs in USD in spine surgery patients undergoing awake vs general anesthesia. Non-comparative studies or those that reported costs in other currencies were excluded. A total of 514 unique records underwent abstract screening, and 9 records were chosen for final study inclusion. Meta-analyses were performed for outcomes reported by at least 2 studies, and statistical significance was defined as p < 0.05. After pooled analysis, awake anesthesia was associated with significantly reduced operative time (MD −14.87 min), anesthesia time (MD −35.28 min), and a shorter hospital LOS (MD −0.51 days). Additionally, anesthesia-related costs (MD −$274.52) and PACU costs (MD −$187.27) were significantly lower in the awake anesthesia group. There were no significant differences in direct costs, total costs, or complication rates between groups. Awake anesthesia for spine surgery is associated with shorter perioperative times, reduced hospital LOS, and decreases in anesthesia and PACU-related costs, while maintaining similar complication profiles to general anesthesia. However, no significant differences were found between groups in direct or total costs. Our findings suggest that although awake anesthesia provides significant cost effectiveness in spine surgery, this is likely due to significant reductions in resource utilization as opposed to direct changes in procedural expenditures.

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