Trends and Long-term Health Care Utilization of Computer-assisted Neuronavigation in Spine Fusions: An Exact Matched Analysis of National Administrative Database

Abstract

Computer-assisted neuronavigation (CAN) during spine fusions has increasingly been utilized in the United States. The aim of this study was to analyze the trends, health care utilization, and clinical outcomes associated with CAN use. The MarketScan database was queried using the ICD-9/10 and CPT 4th edition, from 2003 to 2019. We included patients aged ≥18 years with at least 2 years of follow-up. Outcomes were repeat/new fusions, length of stay (LOS), discharge disposition, hospital re-admissions, outpatient services, and medication refills for up to 24 months. Of 183,620 patients who underwent spine fusions, 5046 (2.75%) were identified to have CAN utilized. CAN is increasingly being utilized for spine fusions since 2010, reaching 10.76% of all fusions in 2017, compared to 0.38% in 2010. CAN had no impact on LOS, home discharge, or complications at index hospitalization and 30-days post discharge. CAN was associated with lower rates of repeat fusions at 6 months (1% vs. 2%) and 24 months (5% vs. 6%), P < 0.05. Patients who underwent CAN had lower payments at 6 months ($5186 vs. $5527, P= 0.0159), 12 months ($10,267 v.s $11,262, P= 0.0207), and 24 months ($21,453 vs. $24,355, P= 0.0021). CAN is increasing being used for spine fusions primarily for thoracolumbar procedures. No difference in complications, discharge disposition, and LOS were noted across the cohorts at index hospitalization, with higher index payments with CAN use. CAN was associated with lower rates of repeat fusions and corresponding health care utilization for up to 24 months.