Effects of Desflurane and Propofol General Anesthesia on Postoperative Recovery Quality in Elderly Patients Undergoing Spinal Surgery: A Randomized Non-Inferiority Trial

Purpose: Postoperative recovery quality is a key concern for elderly patients undergoing spinal surgery, yet evidence comparing different anesthetic techniques in this population remain limited. This study aimed to compare the quality of recovery between desflurane-based inhalational anesthesia and propofol-based total intravenous anesthesia in this population. Patients and Methods: This randomized non-inferiority trial was conducted from July 1 to October 31, 2025. A total of 109 elderly patients scheduled for spinal surgery were randomly assigned to two groups: the desflurane group (group D), which received desflurane at a maintenance dose of 0.7 to 1.0 MAC, and the propofol group (group P), which received propofol at 4 to 6 mg/kg/h. Both groups received standard monitoring and invasive arterial blood pressure measurement. The primary outcome was the quality of recovery (QoR-15) scores on postoperative day 1 (POD1). Secondary outcomes include intraoperative remifentanil and vasopressors requirements, fluid volume, hemodynamic parameters, emergence profiles, duration of post-anesthesia care unit (PACU) stay, postoperative hospital length of stay, Activities of Daily Living (ADL) scale, Mini Montreal Cognitive Assessment (Mini-MoCA), Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), incidence of postoperative nausea and vomiting (PONV), Numeric Rating Scale (NRS) of postoperative pain and subjective sleep quality on POD1 and POD2. Results: =0.017 for non-inferiority). Compared with group P, group D had significantly shorter times to extubation, eye opening, limb movement, orientation recovery, and ability to state one's name, as well as significantly higher Riker Sedation-Agitation Scale scores. Intraoperative phenylephrine consumption and fluid volume were lower in group D than in group P. No significant differences were observed between the two groups in PACU stay duration, postoperative hospital length of stay, ADL scale, Mini-MoCA, CAM-ICU, PONV incidence, NRS pain scores, or subjective sleep quality. Conclusion: Desflurane-based inhalational anesthesia provided a non-inferior quality of recovery compared with propofol. Additionally, desflurane was associated with faster emergence and lower vasopressor requirements. Desflurane and propofol can be considered interchangeable for general anesthesia in elderly patients undergoing spinal surgery.