Wednesday, September 26, 2018 1:00 PM – 2:00 PM Navigation and Intraoperative Monitoring: 48. Computer-assisted navigation in posterior lumbar fusion increases operative time and length of stay

Nathan R Hendrickson; Brandon Wilkinson; Cameron Barton; J. Joseph Gholson; Yubo Gao; Piyush Kalakoti; Andrew J. Pugely

doi:10.1016/j.spinee.2018.06.057

Computer-assisted navigation in lumbar spine surgery has been commercially available since 2000 and has been reported to reduce patient radiation exposure, transpedicular screw insertion errors, and decrease operative time. Adoption rates for navigation in posterior lumbar fusion are unknown, and it is important to determine the impact of navigation on patient outcomes and quality metrics in the thirty-day postoperative period. To determine the adoption rate of computer-assisted navigation and determine short-term complications associated with computer-assisted navigation in posterior lumbar fusion. Retrospective database study using the American College of Surgeons National Quality Improvement Program (ACS NSQIP) database from 2011 to 2015. Patients undergoing elective posterior lumbar spinal fusion were identified in the ACS NSQIP database patients using CPT code 22612, 22633, or 22630. Cases with clean-contaminated, contaminated or dirty/infected wound class were excluded from analysis. We identified cases using intraoperative computer-assisted navigation using secondary CPT code 61783. We compared operative time and length of hospital stay, as well as complications occurring within 30 days of posterior lumbar fusion. Complications were identified from available variables in ACS NSQIP database including superficial infection, deep infection, organ-space infection, wound dehiscence, sepsis, septic shock, pneumonia, urinary tract infection, pulmonary embolism, deep venous thrombosis, unplanned reintubation, renal insufficiency, acute renal failure, stroke, coma, peripheral nerve injury, cardiac arrest, myocardial infarction, reoperation within 30 days, unplanned readmission, and mortality. Patients were stratified based on documentation of intraoperative computer-assisted navigation (CAN) (CPT code 61783). Patient demographics and comorbidities were compared between CAN and non-navigated groups using chi-square and Student t test for categorical and continuous variables, respectively. Operative variables including resident involvement and number of vertebral segments fused were also assessed. Propensity score matching was used to reduce patient selection bias for comparison of thirty-day complication rates between the navigated and traditional lumbar spine fusion groups. A P value of <0.05 was considered statistically significant. There were a total of 25,010 patients in the cohort, with 1,812 (7.2%) cases involving computer-assisted navigation. Navigation adoption rates increased from 3.4% in 2011 to a peak of 9.6% in 2014. Utilization in the most recent study year, 2015, was 7.2%. Short-term complications occurred in 1,973 cases (8.6%). After propensity score matching, operative time was increased 14 minutes in the navigated group (222.0 vs. 205.7 minutes, p<.0001). Length of hospital stay was significantly longer in the navigation group (3.72 vs. 3.47 days, p=.0092). There was no difference in all cause short-term complications between navigated and non-navigated posterior lumbar spinal fusion cases (7.17% vs. 7.23%, p=.9488). Computer-assisted navigation rates of adoption increased from 2011 to 2014, but appeared to plateau in 2015. Computer-assisted navigation is associated with increased operative time and longer hospital stay, but there are no differences in all-cause complications between navigated and non-navigated elective posterior spinal fusion. Thus, while computer assisted navigation is safe to use in lumbar spine surgery, it is unclear if the increased cost and time associated with this technology provide benefits warranting its use in routine lumbar spine surgery. This abstract does not discuss or include any applicable devices or drugs.

Wednesday, September 26, 2018 1:00 PM – 2:00 PM Navigation and Intraoperative Monitoring: 48. Computer-assisted navigation in posterior lumbar fusion increases operative time and length of stay

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