NASS 2022: Robotic and navigational assistance is cost-effective for minimally-invasive adult spinal deformity surgery, new study shows - Spinal News International

Peter Passias

Although robotic and navigational assistance systems person a importantly higher upfront outgo compared to existing techniques, the findings of a new study—presented astatine the North American Spine Society’s (NASS) yearly meeting (12–15 October, Chicago, USA) by Peter Passias (NYU Langone Health, New York, USA)—show that the reductions successful intraoperative invasiveness and operating country (OR) clip they offer, wage large dividends successful demonstrating the two-year cost-effectiveness of specified exertion successful minimally-invasive big spinal deformity surgery.

The retrospective study, which was the recipient of a Value Award astatine NASS 2022, sought to measure differences successful diligent outcomes and comparative outgo effectiveness successful L4-L5 spondylolisthesis patients treated utilizing robotic oregon navigational guidance successful minimally invasive spine country (MISS) procedures.

MISS patients with preoperative diagnoses of L4-L5 spondylolisthesis with baseline and two-year postoperative radiographic/HRQL information were included successful the survey and the cardinal result measures were health-related prime of life, complications and surgical factors. Patients were divided betwixt those operated connected utilizing robotic oregon navigational guidance (Robotic+) oregon not (Robotic-).

Means examination investigation assessed differences successful radiographic and objective outcomes astatine baseline, 1 twelvemonth and 2 years postoperatively. Costs were calculated utilizing the PearlDiver database done estimates from Medicare payscales for services wrong a 30-day window, including estimates regarding costs of postoperative complications, outpatient healthcare encounters, revisions and aesculapian related readmissions.

Quality-adjusted beingness years (QALYs) was calculated utilizing Neck Disability Index (NDI) mapped to the six-dimension wellness authorities abbreviated signifier (SF-6D) utilizing validated methodology, and utilised a 3% discount complaint to relationship for residual diminution to beingness expectancy (78.7 years).

A full of 88 patients (54.40 ± 12.49 years, 40% female, 30.93 ± 6.52 kg/m2, mean Charlson Comorbidity Index [CCI]: 2.23 ± 1.55) with L4-5 spondylolisthesis were included. At baseline, patients were comparable successful age, gender, assemblage wide scale and CCI (all p>0.05). Similarly, patients did not disagree importantly successful baseline determination nor planetary radiographic deformity (all p>0.05).

Perioperatively, the Robotic+ patients were shown to beryllium importantly little apt to acquisition corpectomy (p=0.006), and besides demonstrated importantly little estimated humor nonaccomplishment (p=0.013) and operative clip (p=0.009).

Economic investigation revealed wide outgo savings for Robotic+ patients. Specifically, Robotic+ patients demonstrated accrued inferior gained per QALYs astatine 1 twelvemonth (p=0.028), arsenic good arsenic beingness expectancy QALYs (p=0.002). Furthermore, Robotic+ patients were importantly much apt to show accrued QALYs gained by 2 years (p=0.029).

Conversely, wide outgo per QALY by 2 years was importantly higher for Robotic- patients, which resulted successful an astir 6.5x greater outgo per QALY for specified patients (US$76,848 vs. US$11,839). Overall, Robotic+ patients demonstrated importantly higher cost-effectiveness by 2 years (p<0.001).

Speaking to Spinal News International, Passias said: “With robotic and navigational assistance successful spine country becoming ever much prevalent, appraisal of outgo effectiveness of specified tools is necessary. Especially successful regards to corrective procedures for the attraction of L4-L5 spondylolisthesis, which is among the astir communal pathologies I treat; enhancement of our surgical arsenal successful a cost-effective mode whitethorn pave the mode for betterment of patient-reported and surgical outcomes, and trim costs for each parties involved.

“Of course, we admit that robotic and navigational assistance systems person a importantly higher upfront outgo compared to existing techniques, yet our findings show reductions successful intraoperative invasiveness and OR clip wage large dividends successful cost-effectiveness of specified caller technologies successful minimally-invasive big spinal deformity surgery. At minimum, we urge that institutions and surgeons measure whether oregon not specified technologies are close for them, arsenic we recognise that outgo of attraction remains an important domain wrong our field.”