Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
World Neurosurg. 2022 Oct;166:e850-e858. doi: 10.1016/j.wneu.2022.07.116. Epub 2022 Aug 6.
Computer-assisted neuronavigation (CAN) during spine fusions has increasingly been utilized in the United States. The aim of this study was to analyze the trends, health care utilization, and clinical outcomes associated with CAN use.
The MarketScan database was queried using the ICD-9/10 and CPT 4th edition, from 2003 to 2019. We included patients aged ≥18 years with at least 2 years of follow-up. Outcomes were repeat/new fusions, length of stay (LOS), discharge disposition, hospital re-admissions, outpatient services, and medication refills for up to 24 months.
Of 183,620 patients who underwent spine fusions, 5046 (2.75%) were identified to have CAN utilized. CAN is increasingly being utilized for spine fusions since 2010, reaching 10.76% of all fusions in 2017, compared to 0.38% in 2010. CAN had no impact on LOS, home discharge, or complications at index hospitalization and 30-days post discharge. CAN was associated with lower rates of repeat fusions at 6 months (1% vs. 2%) and 24 months (5% vs. 6%), P < 0.05. Patients who underwent CAN had lower payments at 6 months ($5186 vs. $5527, P = 0.0159), 12 months ($10,267 v.s $11,262, P = 0.0207), and 24 months ($21,453 vs. $24,355, P = 0.0021).
CAN is increasing being used for spine fusions primarily for thoracolumbar procedures. No difference in complications, discharge disposition, and LOS were noted across the cohorts at index hospitalization, with higher index payments with CAN use. CAN was associated with lower rates of repeat fusions and corresponding health care utilization for up to 24 months.
在美国，计算机辅助神经导航（CAN）在脊柱融合术中的应用越来越广泛。本研究旨在分析与 CAN 使用相关的趋势、医疗保健利用和临床结果。
使用 ICD-9/10 和 CPT 第 4 版，从 2003 年到 2019 年，对 MarketScan 数据库进行了查询。我们纳入了年龄≥18 岁且随访时间至少 2 年的患者。结果是重复/新融合、住院时间（LOS）、出院去向、医院再入院、门诊服务和 24 个月内的药物续药。
在接受脊柱融合术的 183620 名患者中，有 5046 名（2.75%）患者使用了 CAN。自 2010 年以来，CAN 越来越多地用于脊柱融合术，2017 年达到所有融合术的 10.76%，而 2010 年为 0.38%。CAN 对索引住院期间和出院后 30 天的 LOS、家庭出院或并发症没有影响。CAN 与 6 个月（1%对 2%）和 24 个月（5%对 6%）时重复融合的发生率较低相关，P<0.05。接受 CAN 的患者在 6 个月（5186 美元对 5527 美元，P=0.0159）、12 个月（10267 美元对 11262 美元，P=0.0207）和 24 个月（21453 美元对 24355 美元，P=0.0021）时的支付金额较低。
CAN 主要用于胸腰椎手术，在索引住院期间，CAN 用于脊柱融合术的使用越来越多，在并发症、出院去向和 LOS 方面没有差异，CAN 使用率较高。CAN 与重复融合的发生率较低和相应的医疗保健利用相关，最长可达 24 个月。
