Comparative analysis of complications, costs, mortality, and length of stay in lumbar fusion surgery: robotic-assisted versus navigation-guided approaches

Abstract

INTRODUCTION: Navigation and robotic technologies emerge as alternatives to conventional freehand techniques for spine fusion. They aim to enhance perioperative and postoperative outcomes, yet their effectiveness remains limited by small cohort sizes in existing literature. Our study compares navigation and robotic technologies in lumbar fusion surgery across complications, costs, and mortality. METHODS: This study employed data from the Nationwide Inpatient Sample. The NIS annually captures approximately 7 million unweighted admissions. The dataset spanned 2016 to 2019, comprising 58,270 patients. Exclusions included non-elective admissions, pre-admission surgeries, and cases reporting $0 hospital costs. Validation of comorbidities and complications was conducted using ICD-10 codes. Analytical techniques, such as trend identification and statistical analyses, were applied with a significance threshold of p < 0.05. Demographic and clinical characteristics, surgery types, and outcomes were assessed. RESULTS: Navigation-guided surgeries dominated (86.7% in 2016, 77.1% in 2019), while Robotic-assisted surgeries increased steadily. Both showed minimal mortality rates. Navigation-guided surgeries had lower charges, lower risks of blood loss anemia, acute kidney injury, and blood transfusion compared to Robotic-assisted surgeries. Navigation-guided surgeries showed significantly lower risks of complications in one level lumbar fusion of vertebral joint and fusion of lumbosacral joint compared to Robotic-Assisted procedures. Additionally, Robotic-Assisted surgeries present higher risks across blood loss anemia, acute kidney injury, and blood transfusion, with risk ratios ranging from 1.24 to 1.72 times higher. CONCLUSION: This study highlights shifting trends in lumbar fusion surgeries, underscoring the need for tailored approaches and nuanced clinical considerations to improve patient outcomes.