Introduction: Increasing technological advances have made the application of robotic technology in spine surgery an operative reality. Here we investigate the cost effectiveness of the addition of robotic technology to an active neurosurgical practice.

Methods: Appropriate modeling analyzed the quantitative impact of the addition of robotic technology to a neurosurgical practice. Time of operative procedures, infection rates, revision rates, length of stay, and possible conversion of open to minimally invasive procedures secondary to robotic image guidance technology was calculated using a combination of institution specific and national data-points. This cost matrix was subsequently applied to one year of elective clinical case volume at an academic practice with regard to payer mix, procedural mix, and procedural revenue.

Results: 557 elective thoraco-lumbar cases were performed over a one year period. 58/557 (10.4%) were minimally invasive fusions. Independent review noted that approximately an additional 10% of cases (50) were determined to be candidates for minimally invasive fusion upon independent review. 41.4% of patients had governmental based insurance while 58.6% had commercial insurance. Time savings was averaged at 3.4 minutes per average one-level MIS procedure with the use of robotic technology. This would have resulted in an annual savings of $5,713. Improved pedicle screw accuracy secondary to robotic technology would have resulted in 9.47 revisions being avoided with a cost savings of $314,661. Under the appropriate payor mix components robotic technology would have resulted in the conversion of 31 Medicare and 18 commercial patients from open to MIS technology. This would have resulted in 140 fewer total hospital admission days ($251,860) and avoided 2.3 infections ($36,312) across the 557 cases studied. Robotic surgery resulted in an immediate conservative estimate savings of $608,546 during a one-year period at an academic center performing 557 elective thoraco-lumbar instrumentation cases.

Conclusions: The application of robotic surgery is a cost-effective emerging technology resulting in decreasing revision surgery, decreasing infection rates, reducing length of stay, and shortening operative time. Future investigation is warranted regarding the impact of robotic technology on specific procedures in both short term and long-term cost and outcomes.

Patient Care: The application of robotic surgery is a cost-effective emerging technology resulting in decreasing revision surgery, decreasing infection rates, reducing length of stay, and shortening operative time. Future investigation is warranted regarding the impact of robotic technology on specific procedures in both short term and long-term cost and outcomes.

Learning Objectives: 1) Understand how robotic surgery can result in less infections, decreased length of stay, fever revisions surgeries, and shortened operating time. 2) Understand the cost effectiveness of integrating robotic technology in spinal care 3) Understand how robotic surgery can increase the utilization of minimally invasive technique

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