P36. Quantifying complications associated with robotic elective spine surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Robot-assisted surgical techniques are being increasingly implemented to increase surgeon accuracy and stamina; however, further investigation of the introductory phase of robot technology on surgical outcomes remains warranted. <h3>PURPOSE</h3> To assess complication rates of robotic surgery in elective spine patients. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> A total of 10,501 elective spine patients. <h3>OUTCOME MEASURES</h3> intra- and postoperative complication rates; reoperation rate. <h3>METHODS</h3> Patients ≥18 years undergoing elective spine surgery with BL to 2-year follow-up were isolated in a single-center spine database. Patients were grouped by absence or presence of robotic assistance during operation. Univariate analyses identified differences in perioperative outcomes [op time, estimated blood loss, length of stay], rates of intraoperative [durotomy, massive blood loss, neurologic deficit] and postoperative complications [cardiopulmonary, neurologic, GI, GU, infection, mechanical], and reoperation rates by 2Y postop]. Regression analysis assessed the impact of robotic surgery on outcomes. <h3>RESULTS</h3> A total of 10,501 patients met inclusion criteria (57years, 49% F, 29.0kg/m2) and underwent elective spine surgery (mean levels fused: 3.0±3.3, EBL: 375mL, op time: 206 min, mean UIV: T9, mean LIV: T12). Of these patients, 424 (4.0%) underwent operation with robotic assistance. Compared to a general cohort of elective spine surgery patients, robotic-assisted surgeries had lower levels fused (1.99 vs 3.07), longer op time (301 vs 202min), and longer LOS (4.2 vs 3.2 days); all p<0.01. Robotic patients were more likely to undergo combined approach (p<0.001). Amongst common primary or concurrent diagnoses of patients undergoing robotic spine surgery, 152 patients (36%) had DDD, 161 patients (38%) HNP, 250 patients (59%) degenerative spondylolisthesis, 287 patients (68%) stenosis, and 228 patients (54%) had radiculopathy. Robotic and non-robotic patients did not differ in terms of functional HRQL outcomes [NDI, EQ5D, NRS Neck, NRS Arm] up to 2-year postop (all p>0.05). Robotic and non-robotic patients did not differ in rates of intraoperative complications, including durotomy, massive blood loss, and delayed extubation (all p>0.05). Robotic patients had higher rates of postop ileus (12% vs 7%, p=0.04), but did not differ in overall postop complications, surgical site infection, cardiopulmonary, mechanical, or neurologic complication. Robotic patients had higher rate of reoperation (6% vs 4%, p=0.004). Regression analysis controlling for revision status, decompression, and approach found that robotic surgery patients had lower odds of delayed extubation (OR: 0.155 p=0.025). Robotic surgery did affect the odds for other complications, including durotomy, neurologic, cardiopulmonary, mechanical, infection, and reoperation (all p>0.05). <h3>CONCLUSIONS</h3> Robotic and non-robotic procedures for elective spine patients were equally as safe in terms of intraoperative and postoperative complications with equivocal functional outcomes up to 2-years postoperatively. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.