Propensity-Matched Comparison of 90-Day Complications in Robotic-Assisted Versus Non-Robotic Assisted Lumbar Fusion

Abstract

Study Design. Retrospective single center propensity-matched observational cohort study that included patients who underwent 1-to 3-level lumbar fusion surgery for degenerative conditions. Objective. To compare 90-day complication rates between robotic-assisted and non-robotic-assisted lumbar spinal fusions in propensity-matched cohorts. Summary of Background Data. A recent administrative database (PearlDiver) study reported increased 30-day complications with the utilization of robotic-assisted enabling technology. Methods. Of 146 robotic-assisted cases that met inclusion criteria, 114 were successfully propensity matched to 114 patients from 214 cases who had 1 to 3 level lumbar fusion without robotic assistance based on age, sex, body mass index, smoking status, American Society of Anesthesiologist grade, number of surgical levels, primary versus revision, and surgical approach (posterior-only or anterior-posterior). We excluded tumor, trauma, infection, or deformity cases. Outcomes included surgical and medical (major/minor) complications at intraoperative, immediately postoperative, 30-and 90-day postoperative intervals, including reoperations, and readmissions within 90 days. Results. All cause intraoperative complication rates were similar between non-robotic-assisted (5.3%) and robotic-assisted groups (10.5%, P ¼ 0.366). Immediate postoperative medical complication rate was also similar between non-robotic-assisted (6.1%) and robotic-assisted groups (1.8%, P ¼ 0.089). Thirty-day complication rates, 90-day complication rates, reoperation rates, and readmission rates showed no difference between nonrobotic-assisted and robotic-assisted groups. There was no difference between return to OR for infection between the cohorts (non-robotic-assisted: 6 [5%] vs. robotic-assisted: 1 [0.8%], P ¼ 0.119). There was however improved length of stay (LOS) in the robotic-assisted group compared with non-roboticassisted group (2.5 vs. 3.17 days, P ¼ 0.018). Conclusion.In propensity-matched cohorts, patients undergoing 1-to 3-level robotic-assisted posterior lumbar fusion for degenerative conditions did not have increased 90-day complication rate, and had a shorter length of stay compared with nonrobotic-assisted patients. There findings differ from a prior administrative database study as the robotic-assisted group in the current study had 0% return to OR for malpositioned screws and 0.8% return to OR for infection.

Is High-Dose Tranexamic Safe in Spine Surgery? A Systematic Review and Meta-Analysis

“…In our systematic literature review we found a pooled medical complication rate after HD TXA consistent with medical complication rates in non-TXA outcomes studies. [28][29][30][31] Furthermore, our meta-analyses provided high-quality evidence that HD TXA is not associated with an increased risk of medical complication after adult or pediatric spine surgery. This lack of association has been previously reported in systematic reviews on the use of TXA in pediatric spine surgery, scoliosis correction, and lumbar interbody fusion.…”

“…First, medical complication rates after spine surgery are widely variable and procedure dependent. [28][29][30][31] There was a wide variety of procedures both within and among the trials. Despite this variability, the finding was consistent in nearly every study, regardless of the dose or population.…”

Risk Factors of Screw Malposition in Robot-Assisted Cortical Bone Trajectory

“…Since 2004 when the SpineAssist (Mazor Robotics Ltd., Caesarea, Israel) was the first widely utilized spine robot to gain FDA approval, RA-instrumented spinal fusion has been widespread among spine surgeons. 6 Even with high initial and maintenance costs, RA spine surgery can be costeffective in the long run by lowering rates of reducing OR time, and shorter length of stay. 6,7,16 Although obesity and osteoporosis can negatively affect screw malposition in RA-PS surgery, 17,18 little is known about the factors affecting the accuracy of RA-CBT screw placement.…”

“…6 Even with high initial and maintenance costs, RA spine surgery can be costeffective in the long run by lowering rates of reducing OR time, and shorter length of stay. 6,7,16 Although obesity and osteoporosis can negatively affect screw malposition in RA-PS surgery, 17,18 little is known about the factors affecting the accuracy of RA-CBT screw placement. [11][12][13]18 From a practical standpoint, this study focused on intraoperatively recognized screw malposition, of which the 2 important mechanisms are skive and shift.…”

“…8 However, these discussions on the safety of RA spine surgery were made about RA-PS surgeries. [6][7][8][9][10] And previous studies on RA-CBT have only compared the accuracy of screw positioning with conventional CBT surgery. [11][12][13] Further investigation about RA-CBT is warranted.…”