Abstract

Purpose/aim:

To compare complications, readmissions, revisions, and payments between navigated and conventional pedicle screw fixation for treatment of spine deformity.

Methods

The Thomson Reuters MarketScan national longitudinal database was used to identify patients undergoing osteotomy, posterior instrumentation, and fusion for treatment of spinal deformity with or without image-guided navigation between 2007-2016. Conventional and navigated groups were propensity-matched (1:1) to normalize differences between demographics, comorbidities, and surgical characteristics. Clinical outcomes and charges were compared between matched groups using bivariate analyses.

Results

A total of 4,604 patients were identified as having undergone deformity correction, of which 286 (6.2%) were navigated. Propensity-matching resulted in a total of 572 well-matched patients for subsequent analyses, of which half were navigated. Rate of mechanical instrumentation-related complications was found to be significantly lower for navigated procedures (p = 0.0371). Navigation was also associated with lower rates of 90-day unplanned readmissions (p = 0.0295), as well as 30- and 90-day postoperative revisions (30-day: p = 0.0304, 90-day: p = 0.0059). Hospital, physician, and total payments favored the conventional group for initial admission (p = 0.0481, 0.0001, 0.0019, respectively); however, when taking into account costs of readmissions, hospital payments became insignificantly different between the two groups.

Conclusions

Procedures involving image-guided navigation resulted in decreased instrumentation-related complications, unplanned readmissions, and postoperative revisions, highlighting its potential utility for the treatment of spine deformity. Future advances in navigation technologies and methodologies can continue to improve clinical outcomes, decrease costs, and facilitate widespread adoption of navigation for deformity correction.

中文翻译：

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脊柱畸形矫正过程中常规与立体定向图像引导的椎弓根螺钉置入：一项国家纵向数据库的回顾性倾向评分匹配研究

摘要

目的/目标：

比较导航和传统椎弓根螺钉固定治疗脊柱畸形的并发症、再入院、翻修和付款。

方法

汤森路透 MarketScan 国家纵向数据库用于识别 2007 年至 2016 年间接受截骨术、后路内固定和融合术治疗脊柱畸形的患者，有或没有图像引导导航。常规组和导航组进行倾向匹配 (1:1)，以使人口统计学、合并症和手术特征之间的差异正常化。使用双变量分析比较匹配组之间的临床结果和费用。

结果

共有 4,604 名患者被确定为接受了畸形矫正，其中 286 名 (6.2%) 接受了导航。倾向匹配导致总共 572 名匹配良好的患者用于后续分析，其中一半被导航。发现导航程序的机械仪器相关并发症的发生率显着降低（p  = 0.0371）。导航也与的90天再入院无计划（低级率相关p  = 0.0295），以及30和90天术后版本（30天：p  = 0.0304，90天：p  = 0.0059）。医院、医生和总付款有利于初次入院的传统组 ( p = 0.0481, 0.0001, 0.0019, 分别）；然而，当考虑到再入院的费用时，两组之间的医院支付变得微不足道。

结论

涉及图像引导导航的手术减少了与器械相关的并发症、计划外的再入院和术后翻修，突出了其治疗脊柱畸形的潜在效用。导航技术和方法的未来进步可以继续改善临床结果，降低成本，并促进导航在畸形矫正中的广泛采用。