180. Do robotic procedures have improved perioperative outcomes after a learning curve period?

Robot-assisted surgical techniques are increasingly implemented to increase surgeon accuracy and stamina; however, the effects of surgeon learning curve on outcomes have not been well studied. Identify differences in outcomes and complication rates between robot-assisted and unassisted lumbar interbody fusions, and determine the presence of a learning curve with regard to surgeon case load. Retrospective review of a single-center stereographic database. This study included 581 robotic assisted surgical patients. Perioperative outcomes (estimated blood loss [EBL], length of stay [LOS]), postoperative complication rates, return to OR (30 days). Robotic cases were isolated from a single center multisurgeon database. Surgeons' cases were ranked by date of surgery into 3 quartiles: 1st quartile 2018 (Early) was analyzed against the 3rd quartile 2020 (Late). Univariate analysis was used to assess differences between quartiles. A propensity score matched (PSM) cohort of patients undergoing identical surgical procedures without robotic assistance was included as a control group and compared to both Early and Late groups. A total of 281 patients undergoing robotic surgery met inclusion criteria (age: 56±12.5, BMI: 30±6, 42% female) with an average of 1.6 levels fused. Early group had 95 patients and Late group had 94. Late group had a lower EBL (314 vs 492, p<0.05), shorter LOS (3.8 vs 4.7, p=.1), greater amount of levels fused (2 vs 1.4, p=.021), greater amount of decompressions (2.5 vs 1, p=.003), with less return to the OR within 30 days (7% vs 14%, p=.2), and a lower rate of overall postoperative complications (34% vs 54%, p=.04). In the control group, the mean EBL was 390±790, LOS 3.7±2.7, overall postoperative complication rate 58%, and rate to return to OR within 30 days was 8%. When the control cohort was compared to the Early robotic cohort, the robotic cohort had a higher EBL (492ml vs 390ml, p<0.05), greater LOS (4.7 vs 3.7 days, p<0.05), greater return to OR within 30 days (14% vs 8%, p=.1), and a comparable overall rate of complications (54% vs 58%, p>0.05). When the control cohort was compared to the Late robotic cohort, the robotic cohort had a lower EBL (314ml vs 390ml, p=.1), comparable LOS (3.7 vs 3.8 days, p>0.05), similar return to OR within 30 days (7% vs 8%, p>0.05), and a lower overall rate of complications (34% vs 58%, p=.02). In this study, perioperative outcomes improved drastically in the later cohort. When compared to an identical control cohort, early robotic cases had worse perioperative outcomes. However, when the later robotics cases were compared to the control cohort, robotic-assisted procedures demonstrate superior clinical outcomes. These findings suggest despite the initial worse outcomes of robotic surgery it proves to be an increasingly viable option for adult spinal deformity surgery. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]