Robotics in Spine: Shorter Stays, Same Complication Rates?

New data suggests that robotic-assisted posterior lumbar fusion for degenerative conditions is not associated with higher complication rates at the 90-day mark. Furthermore, say the authors of this new study, robotic assist often leads to a shorter length of stay.

The study, “Propensity-Matched Comparison of 90-Day Complications in Robotic-Assisted Versus Non-Robotic Assisted Lumbar Fusion,” is published in the February 1, 2022 issue of the journal Spine.

In this retrospective single center propensity-matched observational cohort study, the researchers compared 90-day complication rates between robotic-assisted and non-robotic-assisted lumbar spinal fusions.

All the patients underwent 1-to 3-level lumbar fusion surgery for degenerative conditions.

“A recent administrative database (PearlDiver) study reported increased 30-day complications with the utilization of robotic-assisted enabling technology,” the researchers wrote.

Overall, 114 robotic-assisted cases were propensity matched to 114 patients from 214 cases who had 1 to 3 level lumbar fusion without robotic assistance.

The researchers matched patients based on age, sex, body mass index, smoking status, American Society of Anesthesiologists grade, number of surgical levels, primary versus revision, and surgical approach.

They collected data on a variety of outcomes including surgical and medical complications at intraoperative, immediately postoperative, and 30- and 90-day postoperative intervals.

They found that all cause intraoperative complication rates were similar between non-robotic-assisted and robotic-assisted groups (5.3% vs. 10.5%; p = 0.366). Immediate postoperative medical complication rate, 30-day complication rates, 90-day complication rates, reoperation rates, and readmission rates were also similar between the two groups.

In addition, the researchers reported no difference (emphasis added) between return to OR for infection between non-robotic-assisted and robotic-assisted surgeries (5% vs. 0.8%; p = 0.119).

They, however, did find an improved length of stay in the robotic-assisted group (2.5 vs. 3.17 days; p = 0.018).

“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 non-robotic-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,” they wrote.