73. Comparison of 90-day complications in propensity matched robotic-assisted vs nonrobotic-assisted lumbar fusion: robotic assistance does not increase the complication rate

Abstract

<h3>BACKGROUND CONTEXT</h3> A recent administrative database (PearlDiver) study reported increased 30-day complications with the utilization of robotic-assisted (RA) enabling technology. The authors reported increased fixation-related complications (3%) and infection rates (19%) in RA surgeries. Although there is ample evidence regarding improved pedicle screw accuracy with RA surgery, the complication profile has been called into question. <h3>PURPOSE</h3> The objective of the study is to compare 90-day complication rates between RA and nonrobotic-assisted (NRA) lumbar spinal fusions in propensity-matched cohorts. <h3>STUDY DESIGN/SETTING</h3> Retrospective single center observational propensity-matched observational cohort study. <h3>PATIENT SAMPLE</h3> Patients who underwent 1- to 3-level lumbar fusion surgery for degenerative conditions. <h3>OUTCOME MEASURES</h3> Surgical and medical (major/minor) complications at intraoperative, immediately postoperative, 30- and 90-day postoperative intervals. Additionally, reoperations and readmissions within 90 days. <h3>METHODS</h3> Of 146 RA cases that met inclusion criteria, 114 were successfully propensity matched to 114 patients from 214 cases who had 1-3 level lumbar fusion without robotic assistance based on age, sex, BMI, smoking status, surgical approach (posterior-only or anterior-posterior), ASA grade, revision vs primary, number of surgical levels, and number of interbody levels. We excluded tumor, trauma, infection or deformity cases. Continuous variables were compared using unpaired t-tests and categorical variables were compared using Fisher's exact test with significance set at 0.05. <h3>RESULTS</h3> Consistent with propensity matching, there was no difference in patient demographics and baseline characteristics between groups. Neither group had intraoperative fixation-related complications or required a return to OR for malpositioned screws. All cause intraoperative complication rates were similar between NRA (5.3%) and RA groups (10.5%, p=0.366). Immediate postoperative medical complication rate was also similar between NRA (6.1%) and RA groups (1.8%, p=0.089). Thirty-day complication rates (NRA:15.8% vs RA:12.3%, p=0.446), 90-day complication rates (NRA:15.8% vs RA:14.9%, p=0.854), reoperation rates (NRA:6.1% vs RA:3.5%, p=0.354), and readmission rates (NRA:7.0% vs RA:6.1%, p=0.789) showed no difference between NRA and RA groups. There was no difference between return to OR for infection between the cohorts (NRA:6 [5%] vs RA:1 [0.8%], p=0.119). There was, however, improved length of stay (LOS) in the RA group compared to NRA group (2.5 vs 3.17 days, p=0.018). <h3>CONCLUSIONS</h3> In propensity-matched cohorts, patients undergoing 1- to 3-level level RA posterior lumbar fusion for degenerative conditions did not have increased 90-day complication rate, and had a shorter length of stay compared to NRA patients. There findings differ from a prior administrative database study as the RA group in the current study had 0% return to OR for malpositioned screws and 0.8% return to OR for infection. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.