1531. Cost and Outcomes Associated with Stereotactic Navigation in 2 and 3 6 Level Lumbar Fusions: A Propensity Matched Database Analysis
Authors: Arjun Vivek Pendharkar, MD; Paymon Rezaii, BS; Allen Ho, MD; Eric Sussman, MD; Anand Veeravagu, MD; John Ratliff, MD; Atman Desai, MD (Stanford, CA)
Stereotactic navigation is increasingly used in spine surgery, but its effect on outcomes and costs remain controversial, with several payers not reimbursing its use.
A commercially available longitudinal database was used to identify patients undergoing conventional or navigation based lumbar fusions between 20072015 restricted to one year of continuous enrollment and excluding trauma, tumor or anterior procedures. Propensity matching was performed to normalize differences between demographics and comorbidities in the two cohorts. Outcomes, complications and cost were subsequently analyzed with multivariate logistic regression.
We stratified the cohorts into 1117 conventional and 1117 navigated cases of 2level instrumentation and 804 conventional and 804 navigated matched 36level cases. There were no significant differences in baseline demographics between groups after propensity matching. In 2level lumbar fusion, there was no difference between navigated and conventional groups in length of stay nor the rates of medical or surgical complications within 30 days. Similarly, there was no difference in 30 or 90 day readmission or revision rates between groups. In 36level lumbar fusions, the navigation group had a longer length of stay (3.85 versus 3.44 days; p=0.0012) and a significantly lower risk of having any medical or neurosurgical complication within 30 days for the navigation group (12.3 versus 14.2%; OR 0.48; p=0.0186). The navigation group also had a trend towards lower readmission rates within 180 days (not significant). In both cohorts, hospital payments were significantly higher for the navigated groups.
Our findings suggest that for multilevel instrumented lumbar fusion of six or fewer levels, use of stereotactic navigation may lead to improved outcomes and reduced long term costs. This was not seen for two-level lumbar fusions, suggesting that at a population level, the judicious use of this technology may improve overall value in spinal fusion.