Spine Journal - 2026-06-18 - Journal Article
Robotic Assistance in Posterolateral Lumbar Fusion Is Associated with Higher Comorbidity Burden, Greater 90-Day Infectious Complications, and Increased Episode Costs.
Ng MK, Mastrokostas PG, Cristofoli AJ, Mastrokostas LE, Bijoor V, Friedman AJ, Jagtiani P, Schallmo MS, Dalton J, Meade M, Seddio AE, Varthi A, Monsef JB, Razi AE, Kurd MF, Kaye ID, Woods B, Alvarez AP, Cha TD, Canseco JA, Hilibrand AS, Schroeder GD, Kepler CK, Vaccaro AR
Topics
Key Takeaway
Robot-assisted PLF carries 2.22x higher odds of organ/space SSI (with interbody) and mean 90-day episode costs of $67,400 versus $53,700 for conventional PLF.
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Summary
This study used PearlDiver Mariner claims data (2016–2023) to compare 90-day infectious complications and episode costs across conventional, navigation-assisted, and robot-assisted PLF with and without interbody fusion. On multivariable logistic regression, robotic assistance increased odds of superficial SSI in PLF without interbody (OR 1.53) and organ/space SSI in PLF with interbody (OR 2.22); navigation increased odds of superficial SSI, deep SSI, and wound dehiscence in both cohorts. Mean 90-day costs were highest for robotics ($67,400 without interbody; $65,200 with interbody) versus conventional ($53,700; $51,800).
Key Limitation
Claims data cannot distinguish whether higher complication rates reflect the technology itself, greater baseline patient complexity, or surgeon learning-curve effects, precluding any causal conclusion about robotic or navigation systems as independent risk factors.
Original Abstract
BACKGROUND CONTEXT
Navigation and robotic assistance are increasingly used during posterolateral lumbar fusion (PLF), yet comparative associations with early wound/infectious complications and short-term costs remain incompletely characterized in large claims-based cohorts.
PURPOSE
To compare patient characteristics, 90-day wound/infectious complications, and 90-day episode-of-care costs among conventional, navigation-assisted, and robot-assisted PLF (with and without interbody fusion).
STUDY DESIGN/SETTING
Retrospective cohort study using a national administrative claims database (PearlDiver Mariner), 2016-2023.
PATIENT SAMPLE
Adult patients undergoing PLF, stratified by PLF without interbody fusion and PLF with interbody fusion.
OUTCOME MEASURES
90-day postoperative superficial surgical site infection (SSI), deep SSI, organ/space SSI, wound dehiscence, and 90-day episode-of-care costs.
METHODS
The PearlDiver Mariner database was queried to identify adult PLF cases performed conventionally, with navigation assistance, or with robotic assistance. Outcomes were assessed at 90 days. Multivariable logistic regression was performed for complications. Statistical significance was set at P < 0.05.
RESULTS
We identified 305,313 PLF cases (150,293 without interbody; 155,020 with interbody). In PLF without interbody (ref = conventional), robot-assistance increased odds of superficial SSI (OR 1.53, P < 0.001). Navigation increased odds of superficial SSI (OR 1.32, P < 0.001), deep SSI (OR 1.23, P < 0.001), and wound dehiscence (OR 1.09, P = 0.005). In PLF with interbody, robot-assistance increased odds of organ/space SSI (OR 2.22, P = 0.002), and navigation increased odds of superficial SSI (OR 1.21, P < 0.001), deep SSI (OR 1.15, P = 0.019), organ/space SSI (OR 1.66, P < 0.001), and wound dehiscence (OR 1.07, P = 0.033). Mean 90-day costs were highest with robotics ($67,400 no-interbody; $65,200 interbody) vs navigation ($58,700; $56,300) and conventional ($53,700; $51,800; P ≤ 0.05 for all).
CONCLUSIONS
Technology-assisted PLF cohorts demonstrated higher comorbidity burden, greater 90-day infectious/wound complication rates, and higher costs than conventional PLF cohorts. This association should be interpreted in the context of greater baseline complexity and potential learning-curve effects in technology-assisted cohorts.