Do Robotic Procedures Have Improved Perioperative Outcomes After Overcoming the Learning Curve? — The International Society for the Study of the Lumbar Spine
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Do Robotic Procedures Have Improved Perioperative Outcomes After Overcoming the Learning Curve? (#1122)

Peter Passias 1 , Oscar Krol 1 , Rachel Joujon-Roche 1 , Bailey Imbo 1 , Tyler Williamson 1 , Peter Tretiakov 1 , Jordan Lebovic 1 , Stephane Owusu-Sarponh 1 , Justin Smith 2 , Virginie Lafage 3 , Renaud Lafage 4 , Shaleen Vira 5 , Andrew Schoenfeld 6
  1. Department of Orthopaedic Surgery, NYU Langone, New York, NY, United States
  2. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
  3. Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
  4. Hospital for Special Surgery, New York
  5. UT Southwestern, Dallas
  6. Department of Orthopedic Surgery, Brigham and Women's Center for Surgery and Public Health, Boston, MA, USA

Background:  Robot-assisted surgical techniques are being increasingly implemented in spine surgery to increase accuracy and mitigate surgeon stamina. There are known variations in the learning curve required for effective use however literature on the effect of robot-assisted techniques on perioperative outcomes, after overcoming the learning curve, remains scarce.

Methods: Robot-assisted cases were isolated from a single-center multi-surgeon database. Cases were ranked by the date of surgery into 3 tertiles. The 1st Tertile, 2018, denoted as “Early,” was analyzed against the 3rd Tertile, 2020, denoted as “Late.” Univariate analysis was used to assess differences between tertiles. Propensity score matched (PSM) cohorts of patients who underwent identical surgical procedures (matched for age, BMI, levels fused, surgical approach, and type of interbody fusion) without robotic assistance were included as control groups and compared to both Early and Late groups.

Results: A total of 388 patients met inclusion criteria (Age: 56±12.5, BMI: 30±6, 42% female). 26.3% had an ALIF, 11.3% had an LLIF, and 57.7% had a TLIF. The Early group had 110 patients and the Late group had 112. Comparison of Early vs Late baseline demographics showed no differences in age, BMI, gender, or ASA status. The Early and Late groups had similar levels fused (2.14 versus 2.18, p=0.8), comparable LOS (4.3 vs 4.5 days, p=0.7), comparable operative time (288min vs 310 min, p=0.35), comparable return to the OR by 30 days (4% vs 2%), and comparable return to the OR by 90 days (12% vs 9%, p=0.62). Late cohort had more levels decompressed (2.3 versus 0.9, p<0.001). The Late group had a lower EBL (604ml vs 367ml, p= 0.043), fewer intraoperative complications (5% vs 10%, p=.2), and less postoperative complications (54% vs 39%, p= =0.025),). Compared to the control group (no robotic assistance), the Early robotic cohort had less return to the OR by 30 days (4% vs 15%,p=0.12) and 90 days (12% vs 15%, p=0.6). Conversely, the Early robotic cohort had a higher EBL (604ml vs 551ml, p=0.16). There was comparable LOS (4.5 vs 4.5 days, p=0.4), operative time (310min vs 330min p=0.31), intraoperative complications (10% vs 12%, p= 0.52), and postoperative complications (54% vs 54%, p =0.4) between the Early robotic cohort and the control group. Compared to the control group, the Late robotic group had a lower EBL (367ml vs 550ml, p= 0.007), shorter operative time (288min vs 330 min, p= 0.005), less return to the OR by 30 days (2% vs 15%, p=0.028) and 90 days (9% vs 15%, p=.33), less intraoperative complications (5% vs 12%, p =0.074), fewer postoperative complications (54% vs 39%, p =0.04). There was comparable LOS (4.4 vs 4.5 days, p=0.6) between the Late robotic group and the control group.

Discussion: There is a substantial learning curve that exists prior to maximizing the surgical outcomes after robot-assisted spine surgery. Increasing caseload over time helps mitigate the learning curve, resulting in shorter LOS, less blood loss, and fewer complications. These outcomes may be superior to those experienced by patients undergoing non-robotic surgery.

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