MINIMALLY INVASIVE COLECTOMY UNDER NEURAXIAL ANESTHESIA IN FRAIL PATIENTS. SPICO STUDY

Introduction. General anesthesia is the most widely used anesthesia technique for major abdominal surgery, but it may have longer recovery time, high cost and environmental impact. In addition, general anesthesia may be contraindicated in some frail patients. Our study aims to evaluate the feasibility and safety of performing colorectal surgery with minimally invasive technique, in frail patients, under spinal anesthesia. Then we compared this group of patients with a retrospective one, performing a propensity score match analysis. Materials and methods. From June 2021 to June 2023, all frail patients, undergoing colic resection surgery with laparoscopic technique under spinal anesthesia at the Colorectal Surgery of the “Fondazione Policlinico Campus Bio-Medico of Rome” were enrolled. We compered these patients with a historical cohort, performing a propensity score match analysis. Results. We enrolled 87 patients. 4 patients refused surgery under neuraxial anesthesia, and 2 patients required a conversion to general anesthesia. In all patients, the surgery was successfully completed with minimally invasive technique. Some the patients experienced mild abdominal pain between I and II GPO (VAS between 3 and 5) treated with oral analgesics as needed. No patients experienced episodes of vomiting or nausea after surgery with gas channeling in I GPO. The average hospital stay was about 4 days (range 3-7). 5 patients (6.9%) required ICU admission, but 30 mortality was 0. Propensity score match (1:1) with a retrospective cohort (each group of 72 patients) showed a statistically significance reduction in ICU stays and length of stay (respectively p < 0.001 e p 0.03). Surgical complications were also reduced, in particular, anastomotic leakage (p = 0.06) and Pneumonia (p = 0.09), but with no statistical significance. Conclusions. Our preliminary data show that performing major surgery with minimally invasive technique under spinal anesthesia can be feasible and safe, if performed by experienced operators, and can be a viable alternative for the treatment of frail and/or high-risk patients, with a reduction of ICU admission, hospital stay and post-operative complications.