Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA.
J Orthop Surg Res. 2021 May 12;16(1):308. doi: 10.1186/s13018-021-02452-z.
Robot-assisted platforms in spine surgery have rapidly developed into an attractive technology for both the surgeon and patient. Although current literature is promising, more clinical data is needed. The purpose of this paper is to determine the effect of robot-related complications on clinical outcomes METHODS: This multicenter study included adult (≥18 years old) patients who underwent robot-assisted lumbar fusion surgery from 2012-2019. The minimum follow-up was 1 year after surgery. Both bivariate and multivariate analyses were performed to determine if robot-related factors were associated with reoperation within 1 year after primary surgery.
A total of 320 patients were included in this study. The mean (standard deviation) Charlson Comorbidity Index was 1.2 (1.2) and 52.5% of patients were female. Intraoperative robot complications occurred in 3.4% of patients and included intraoperative exchange of screw (0.9%), robot abandonment (2.5%), and return to the operating room for screw exchange (1.3%). The 1-year reoperation rate was 4.4%. Robot factors, including robot time per screw, open vs. percutaneous, and robot system, were not statistically different between those who required revision surgery and those who did not (P>0.05). Patients with robot complications were more likely to have prolonged length of hospital stay and blood transfusion, but were not at higher risk for 1-year reoperations. The most common reasons for reoperation were wound complications (2.2%) and persistent symptoms due to inadequate decompression (1.5%). In the multivariate analysis, robot related factors and complications were not independent risk factors for 1-year reoperations.
This is the largest multicenter study to focus on robot-assisted lumbar fusion outcomes. Our findings demonstrate that 1-year reoperation rates are low and do not appear to be influenced by robot-related factors and complications; however, robot-related complications may increase the risk for greater blood loss requiring a blood transfusion and longer length of stay.
脊柱外科中的机器人辅助平台已迅速成为外科医生和患者都感兴趣的一项有吸引力的技术。尽管目前的文献很有前景，但仍需要更多的临床数据。本文的目的是确定机器人相关并发症对临床结果的影响。
本多中心研究纳入了 2012 年至 2019 年间接受机器人辅助腰椎融合术的成年（≥18 岁）患者。术后至少随访 1 年。进行了单变量和多变量分析，以确定机器人相关因素是否与初次手术后 1 年内再次手术有关。
本研究共纳入 320 例患者。平均（标准差）Charlson 合并症指数为 1.2（1.2），52.5%的患者为女性。术中机器人并发症发生率为 3.4%，包括术中螺钉更换（0.9%）、机器人放弃（2.5%）和因螺钉更换返回手术室（1.3%）。1 年再手术率为 4.4%。机器人相关因素，包括每颗螺钉的机器人时间、开放与经皮、机器人系统，在需要修订手术的患者和未进行修订手术的患者之间无统计学差异（P＞0.05）。发生机器人并发症的患者更有可能出现住院时间延长和输血，但 1 年再手术风险并未增加。再次手术的最常见原因是伤口并发症（2.2%）和因减压不足导致的持续性症状（1.5%）。多变量分析显示，机器人相关因素和并发症不是 1 年再手术的独立危险因素。
这是最大的多中心研究，专注于机器人辅助腰椎融合的结果。我们的研究结果表明，1 年再手术率较低，似乎不受机器人相关因素和并发症的影响；然而，机器人相关并发症可能会增加因失血较多需要输血和住院时间延长的风险。
