22. Robotic assisted vs conventional posterior lumbar fusion: An analysis of 90-day complications and readmissions

Abstract

<h3>BACKGROUND CONTEXT</h3> Although robotic-assisted spinal fusion is gaining traction in the United States, little is known whether the robotic assistance during pedicle screw placement is associated with lower complication rates following elective posterior lumbar fusions. <h3>PURPOSE</h3> The purpose of this study was to assess whether robotic-assistance in elective posterior lumbar fusions is associated with a difference in the rates of 90-day medical and surgical complications. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of administrative claims data. <h3>PATIENT SAMPLE</h3> This was a retrospective review of insurance claims from an all-payer dataset, Symphony Integrated DataVerse (IDV). The Symphony IDV was queried using International Classification of Diseases 10th Edition (ICD-10) procedure codes to identify patients undergoing elective posterior lumbar fusions for degenerative spine pathologies between 2015 and 2018. Patients undergoing cervical fusions, thoracic fusions and/or fusions for deformity, malignancy and trauma were excluded from the study. Patients undergoing concurrent anterior fixation and/or combined fusions were also removed from the study. ICD-10 procedure codes (8E0W4CZ, 8E0W0CZ, 8E0W3CZ) were used to identify patients undergoing a robotic-assisted spinal fusion. <h3>OUTCOME MEASURES</h3> Ninety-day medical and surgical complications. <h3>METHODS</h3> Multivariate logistic regression analyses were used to assess whether undergoing a robotic-assisted fusion (vs conventional fusion) was associated with differences in wound complications, medical complications, pseudarthrosis, revision surgery and readmissions within 90 days of surgery (adjusting for age, gender, region, comorbidity burden, use of interbody, payor/plan type, length of fusion [1-level vs greater than 1 level]). <h3>RESULTS</h3> Following application of inclusion/exclusion criteria, a total of 39,387 patients undergoing elective posterior lumbar fusions were included in the cohort, out of which 245 (0.6%) underwent a robotic-assisted fusion. Multivariate analysis showed that robotic-assisted fusion (vs conventional fusion) was not associated with significant differences in 90-day rates of pseudarthrosis (p=0.945), wound complications (p=0.299), urinary tract infections (p=0.648), acute myocardial infarctions (p=0.209), acute renal failure (p=0.461), pneumonia (p=0.214), stroke (p=0.917), deep venous thrombosis (p=0.562), pulmonary embolism (p=0.401), revision fusion (p=0.862), readmissions (p=0.985). <h3>CONCLUSIONS</h3> Using a cohort of nearly 40,000 patients undergoing posterior lumbar fusion, our findings show that patients who underwent a robotic-assisted fusion had similar rates of surgical and medical complications, as compared to those who underwent a conventional fusion. Further studies using more granular prospective data that collects information on patient-reported outcomes, is warranted to better understand the future role of robots in spine surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.