Outcomes after navigated lumbar fusion: Readmission, reoperation, and complications in 18,561 procedures.

BACKGROUND

Stereotactic navigation (SN) has become increasingly prominent in lumbar fusion (LF) surgeries because of its ability to generate a three-dimensional representation of the patient's anatomy in relation to surgical instrumentation. The purpose of this study was to investigate differences in clinical outcomes for patients undergoing navigated LF surgery (nLF) versus conventional LF surgery (cLF), and additionally, to examine trends in SN usage and economic variables.

METHODS

This propensity score-matched retrospective cohort study used data from the Premier Healthcare Database. ICD-10 and CPT codes were used to identify patients undergoing primary LF, establish nLF and cLF cohorts, and identify outcomes. Comparative statistical methods included the Cox proportional hazards model, negative binomial regression, and Pearson's Chi-square test. Trends in usage of SN were investigated using linear and exponential regression. Descriptive statistics for patient charge and cost were generated.

RESULTS

After matching, each combined cohort contained 18,561 patients. The single-level cohorts contained 10,439 patients and the multilevel contained 8,122. Time-based risk of reoperation within two years of index procedure was reduced in the combined nLF cohort (HR = 0.877, 95% CI: 0.805-0.955, p = 0.00250) and the single-level nLF cohort (HR = 0.836, 95% CI: 0.736-0.949, p = 0.00569). Additionally, all nLF cohorts saw reduced rates of 30-day and 90-day readmission. All nLF cohorts had greater rates of blood transfusion and longer LOS compared to cLF. Utilization of nLF increased exponentially from 2016 to 2020 (R2 = 0.854, p < 0.001).

CONCLUSION

nLF was associated with reduced readmission rates in all cohorts, and reduced reoperation rates for single- but not multilevel lumbar fusion. The reduced reoperation rate in the combined cohort may be driven by the single-level procedures. Further research may be done to investigate the main drivers of reoperation and readmission in navigated cases.