Assistant Professor of Neurosurgery Washington University School of Medicine St. Louis, Missouri, United States
Disclosure(s):
Peter G. Passias, MD: No relevant disclosure to display
Introduction: Spine surgery has seen technological advancements including minimally invasive surgery (MIS) and robot-assisted techniques. Given the relative novelty and increasing prevalence of robotic-assistance, there is a paucity of literature examining cost. Our study aims to assess impact of robotic-assistance on cost utility in patients undergoing minimally invasive thoracolumbar spine surgery.
Methods: A retrospective analysis of patients prospectively enrolled in a single center MIS database. Patients >18 years with baseline (BL) and 2-year (2Y) follow-up were included. Patients grouped by utilization of robotic assistance: MIS Robotic (MIS-R) vs. MIS Non-Robotic (MIS-NR). Multivariable analysis (MVA) assessed differences in outcomes, including complications, reoperations, and HQRLs, while accounting for covariates. Cost data was based on average Medicare reimbursement by DRG. Utility was calculated using ODI converted to SF-6D, and used to assess QALYs gained and cost/QALY 2Y.
Results: 222 patients included (63% MIS-R vs. 37% MIS-NR). mean baseline SVA 15.45±34.40mm, PI-LL 1.41±12.17°, and PT 16.24±8.80°. MIS-R patients had significantly lower CCI vs. MIS-NR patients (2.67±1.58 vs. 1.80±1.26, p < .001). No differences in BL age, gender, BMI, or BL deformity between groups. MVA found MIS-R patients had significantly lower EBL (p=.033) and lower overall complications (21.4% vs. 37.9%, p=.016), reoperations (2.90% vs. 19.0%, p < .005), readmissions (2.1% vs. 8.6%, p=.035). Mean utility 2Y was 0.101 for NR-MIS patients vs. 0.132 for R-MIS and mean QALYs 2Y was 0.885 for NR-MIS patients vs. 0.915 for R-MIS. Mean cost 2Y was $51,120 for NR-MIS vs. $47,189 for R-MIS patients, equated to mean cost/QALY 2Y of $260,647 for NR-MIS vs. $183,858 R-MIS.
Conclusion : MIS Robotic patients demonstrated lower rates of readmissions and reoperations than non-robotic counterparts. These outcomes in the robotic assistance group resulted in superior cost utility at 2Y post-op, suggesting that use of robotic assistance in MIS spine surgery has the potential to minimize patient complications and improve cost effectiveness.
