Anaesthetic modalities and post-operative outcomes in spinal cord injury urolithiasis: A systematic review

Abstract

Objectives:

Spinal cord injury (SCI) patients are at an increased risk of urolithiasis and are associated with increased perioperative morbidity and mortality. The optimal anaesthetic agent in these patients remains contentious, reflecting a paucity of large-scale clinical trials. This systematic review aims to summarise the existing evidence comparing general anaesthesia (GA) with non-GA induction for surgical treatment of stones for these patients.

Materials and methods:

Ovid MEDLINE, Cochrane, and PubMed databases were searched up to 30 March 2024. Eligible studies assessed SCI patients receiving surgical procedures for stones with a specified anaesthetic induction method detailed. Our primary outcomes were stone-free rate (SFR) and all-cause mortality. Secondary outcomes included intraoperative and post-operative complications, intensive care admissions, and mean hospital stay.

Results:

Fifteen cohort, observational, and case–control studies were included. The available data demonstrated no meaningful trend between cohorts receiving GA and non-GA induction, across all outcomes. Studies exhibited significant heterogeneity in the direct comparison of GA with non-GA methods. Type of non-GA method, incidence of complications and outcome reporting were inconsistently reported, precluding reliable meta-analysis. Methodological quality was scored on the modified Newcastle Ottawa Scale which found eligible studies to be of poor to good quality.

Conclusion:

Evidence around outcomes in non-GA and GA-induced treatment is inconclusive and poor. We suggest larger scale, prospective studies to further stratify risk of poor outcomes between these two groups.