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. 2022 Dec 2;6(12):e22.00137.
doi: 10.5435/JAAOSGlobal-D-22-00137. eCollection 2022 Dec 1.

Index Surgery Cost of Fluoroscopic Freehand Versus Robotic-Assisted Pedicle Screw Placement in Lumbar Instrumentation: An Age, Sex, and Approach-Matched Cohort Comparison

Ekene Uchenna Ezeokoli  1 , Mitchell Pfennig, Jithin John, Rohun Gupta, Jad G Khalil, Daniel K Park
Affiliations

Index Surgery Cost of Fluoroscopic Freehand Versus Robotic-Assisted Pedicle Screw Placement in Lumbar Instrumentation: An Age, Sex, and Approach-Matched Cohort Comparison

Ekene Uchenna Ezeokoli et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

Background: Spine surgery costs are notoriously high, and there are already criticisms and concerns over the economic effects. There is no consensus on cost variation with robot-assisted spine fusion (rLF) compared with a manual fluoroscopic freehand (fLF) approach. This study looks to compare the early costs between the robotic method and the freehand method in lumbar spine fusion.

Methods: rLFs by one spine surgeon were age, sex, and approach-matched to fLF procedures by another spine surgeon. Variable direct costs, readmissions, and revision surgeries within 90 days were reviewed and compared.

Results: Thirty-nine rLFs were matched to 39 fLF procedures. No significant differences were observed in clinical outcomes. rLF had higher total encounter costs (P < 0.001) and day-of-surgery costs (P = 0.005). Increased costs were mostly because of increased supply cost (0.0183) and operating room time cost (P < 0.001). Linear regression showed a positive relationship with operating room time and cost in rLF (P < 0.001).

Conclusion: rLF is associated with a higher index surgery cost. The main factor driving increased cost is supply costs, with other variables too small in difference to make a notable financial effect. rLF will become more common, and other institutions may need to take a closer financial look at this more novel instrumentation before adoption.

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Conflict of interest statement

Dr. Khalil or an immediate family member has received royalties from Camber Spine; is a member of a speakers’ bureau or has made paid presentations on behalf of Camber Spine, Centinel Spine, Johnson & Johnson, Medtronic, Relievant Medsystems, and Stryker; serves as a paid consultant to Camber Spine, Centinel Spine, Medtronic, Relievant Medsystems, SI Bone, and Stryker; has stock or stock options held in Johnson & Johnson, Medtronic, and Nuvasive; has received research support from Centinel Spine, Fziomed, Innovative Surgical Designs, Johnson & Johnson, Limiflex, Medtronic, Relievant, and Stryker; and serves as a board or committee member of the American Academy of Orthopaedic Surgeons; serves on the editorial or governing board of the Journal of the American Academy of Orthopaedic Surgeons. Dr. Park or an immediate family member serves as a paid consultant to Arthrex, Kuros, Orthofix, Solco, Stryker, and Theramatrix; has stock or stock options held in Johnson and Johnson, Stryker, and Surgalign; serves as a board or committee member of the American Academy of Orthopaedic Surgeons and the Cervical Spine Research Society; and serves on the editorial or governing board of Orthoinfo. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Ezeokoli, Pfennig, John, and Gupta.

Figures

Figure 1
Figure 1
Graph showing day-of-surgery VDC distribution in rLF compared with fLF. fLF = fluoroscopic freehand, rLF = robot-assisted spine fusion, VDC = variable direct cost
Figure 2
Figure 2
Graphs showing linear regression of OR time and day-of-surgery VDC for rLF (left) versus fLF (right). fLF = fluoroscopic freehand, OR = operating room, rLF = robot-assisted spine fusion, VDC = variable direct cost
See this image and copyright information in PMC

References

    1. Wray S, Mimran R, Vadapalli S, Shetye SS, McGilvray KC, Puttlitz CM: Pedicle screw placement in the lumbar spine: Effect of trajectory and screw design on acute biomechanical purchase. J Neurosurg Spine 2015;22:503-510. - PubMed
    1. Lieberman IH, Kisinde S, Hesselbacher S: Robotic-assisted pedicle screw placement during spine surgery. JBJS Essent Surg Tech 2020;10:e0020. - PMC - PubMed
    1. Kantelhardt SR, Martinez R, Baerwinkel S, Burger R, Giese A, Rohde V: Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J 2011;20:860-868. - PMC - PubMed
    1. Hu X, Ohnmeiss DD, Lieberman IH: Robotic-assisted pedicle screw placement: Lessons learned from the first 102 patients. Eur Spine J 2013;22:661-666. - PMC - PubMed
    1. Molliqaj G, Schatlo B, Alaid A, et al. : Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurg Focus 2017;42:E14. - PubMed