P76. Economic impact of the initial incorporation of robotics in spine surgery

Abstract

BACKGROUND CONTEXT There have been few investigations into national trends in outcomes and costs associated with the assimilation of robotic assisted surgery. In order to improve cost efficiency, further research is needed into the drivers of higher charge ratios. PURPOSE To evaluate if incorporation of robotic assisted spine surgeries will lead to a rise in cost without a significant improvement in outcomes. STUDY DESIGN/SETTING Retrospective review of a national patient database between 2010-2016. PATIENT SAMPLE A total of 4,185 discharges. OUTCOME MEASURES Cost-to-Charge ratio, length of stay, invasiveness. METHODS Included: elective spine surgery procedures from 2010-2016 as defined by ICD-9/10-CM codes. Descriptive statistics assessed demographics for the cohort. Rates of open and MIS robot assisted procedures, trends in postoperative complications, length of stay, total charges, CCR and hospital location were assessed. PSM was performed between robotic and nonrobotic spine surgery patients for levels fused. Regression analysis was used to evaluate robot assisted procedures as a predictor of postop complications, extended LOS (LOS above 75th percentile), higher total charges (charges above 75th percentile), higher cost to charge ratio (CCR above 75th percentile), unfavorable discharge and death. RESULTS A total of 4,185 discharges were included (age 59.7 ± 16.2, 55% female, average severity of illness score 1.87 ± 0.83). Overall, there has been a significant increase in robot assisted surgeries from 2010 to 2016 increasing from 11 recorded cases to 1,535 in 2016 (p<0.001). There has been a significant increase in total charges from 2010-2016, with a mean high of $455,210.91 in 2011 (p<0.001). However, there has been a decrease in CCR from 2012 to 2016 (0.33 compared to 0.24. p<0.001). Average length of stay has significantly decreased from 9.5 days in 2010 to 4.4 days in 2016 (p<0.001), while 50% of patients have been unfavorably discharged since 2012. When compared to 4,185 invasiveness match non-robotic patients, robot assistance was not significantly associated with higher total charges, however it was significantly associated with higher CCR (OR: 2.4 [2.15-2.69], p<0.001). CONCLUSIONS Compared to invasiveness matched nonrobotic patients, robot assisted patients had significantly higher odds of having a high cost to charge ratio for their hospital encounter, despite having similar total charges. Cost to charge increase due to technology may represent an added financial burden that is developing so clinical benefit of new technology is warranted. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. There have been few investigations into national trends in outcomes and costs associated with the assimilation of robotic assisted surgery. In order to improve cost efficiency, further research is needed into the drivers of higher charge ratios. To evaluate if incorporation of robotic assisted spine surgeries will lead to a rise in cost without a significant improvement in outcomes. Retrospective review of a national patient database between 2010-2016. A total of 4,185 discharges. Cost-to-Charge ratio, length of stay, invasiveness. Included: elective spine surgery procedures from 2010-2016 as defined by ICD-9/10-CM codes. Descriptive statistics assessed demographics for the cohort. Rates of open and MIS robot assisted procedures, trends in postoperative complications, length of stay, total charges, CCR and hospital location were assessed. PSM was performed between robotic and nonrobotic spine surgery patients for levels fused. Regression analysis was used to evaluate robot assisted procedures as a predictor of postop complications, extended LOS (LOS above 75th percentile), higher total charges (charges above 75th percentile), higher cost to charge ratio (CCR above 75th percentile), unfavorable discharge and death. A total of 4,185 discharges were included (age 59.7 ± 16.2, 55% female, average severity of illness score 1.87 ± 0.83). Overall, there has been a significant increase in robot assisted surgeries from 2010 to 2016 increasing from 11 recorded cases to 1,535 in 2016 (p<0.001). There has been a significant increase in total charges from 2010-2016, with a mean high of $455,210.91 in 2011 (p<0.001). However, there has been a decrease in CCR from 2012 to 2016 (0.33 compared to 0.24. p<0.001). Average length of stay has significantly decreased from 9.5 days in 2010 to 4.4 days in 2016 (p<0.001), while 50% of patients have been unfavorably discharged since 2012. When compared to 4,185 invasiveness match non-robotic patients, robot assistance was not significantly associated with higher total charges, however it was significantly associated with higher CCR (OR: 2.4 [2.15-2.69], p<0.001). Compared to invasiveness matched nonrobotic patients, robot assisted patients had significantly higher odds of having a high cost to charge ratio for their hospital encounter, despite having similar total charges. Cost to charge increase due to technology may represent an added financial burden that is developing so clinical benefit of new technology is warranted.