The Impact of Computer-Assisted Navigation on Charges and Readmission in Lumbar Spinal Fusion

Study Design: Retrospective National Database Study. Objectives: The purpose of this study is to evaluate the cost and patient outcomes associated with the utilization of computer-assisted navigation (CAN) utilization on patients undergoing lumbar spinal fusion. Background: CAN systems have demonstrated comparable outcomes with instrumentation and procedural speed when compared with traditional techniques. In recent years, CAN systems have seen increased adoption in spinal surgery as they allow for better contextualization of anatomical structures with the goal of improving surgical accuracy and reproducibility. Methods: The 2016 National Readmission Database was queried for patients with lumbar spinal fusion ICD-10 codes, with 2 subgroups created based on computer-aided navigation ICD-10 codes. Nonelective cases and patients below 18 years of age were excluded. Univariate analysis on demographics, surgical data, and total charges was performed. Postoperative complication rates were calculated based on diagnosis. Lastly, multivariate analysis was performed to assess navigation's impact on cost and postoperative outcomes. Results: A total of 88,445 lumbar fusion surgery patients were identified. Of the total, 2478 (2.8%) patients underwent lumbar fusion with navigation utilization, while 85,967 (97.2%) patients underwent surgery without navigation. The average total charges were $150,947 ($150,058, $151,836) and $161,018 ($155,747, $166,289) for the non-CAN and CAN groups, respectively (P<0.001). The 30-day readmission rates were 5.3% for the non-CAN cohort and 3.1% for the CAN cohort (P<0.05). The 90-day readmission rates were 8.8% for the non-CAN cohort and 5.2% for the CAN cohort (P<0.001). Conclusions: CAN use was found to be significantly associated with increased cost and decreased 30-day and 90-day readmissions. Although patients operated on with CAN had increased routine discharge and decreased readmission risk, future studies must continue to evaluate the cost-benefit of CAN. Limitations include ICD-10 codes for CAN utilization being specific to region of surgery, not to exact type. Level of Evidence: Level III.