Robotic spine surgery has grown from 80,000 surgeries to 205,000 surgeries in the past three years, and more surgeons are training on the technology each day.
What are the economics behind robotic spine surgery? Does the technology have a return-on-investment?
The robotic systems are a significant capital expense — anywhere from $1 million to $2.5 million per system. The robotic technology will then increase the cost of procedures anywhere from $3,200 to $8,000 per surgery. In a world where stakeholders are looking to lower costs, it might seem counter-intuitive to add these expenses. But the value proposition could actually lower the overall cost of care by improving quality.
"I see the potential to recover the costs because the robotic technology makes surgeons more accurate and the procedures safer," says Jae Y. Lim, MD, a spine surgeon at Atlantic Brain and Spine in Northern Virginia. "That's not easy to measure, but you can see the robotic guidance makes surgeries more accurate and there is a lower risk of complications. Patients don't have to return for a re-do surgery."
The technology could also make the procedure faster, after surgeons and OR staff overcome the learning curve. With familiarity, surgeons can move more quickly with confidence and they don't have to perform repetitive intraoperative x-rays to check placement during the procedure.
"If you are saving time, that's an immediate cost savings to the healthcare system," says Dr. Lim. "At a typical hospital, minutes in the OR cost thousands of dollars. When you are saving 30 minutes per case it can make a huge difference."
The enhanced accuracy of the screw placement for minimally invasive procedures can also lower the length-of-stay at the hospital and decrease pain for the patient. Long hospital stays are costly for the healthcare system, and strong pain medications put patients on a longer road to recovery and returning to full activity. When they have less pain and take less pain medication, patients can return-to-work or daily activity quicker and make an impact on the economy.
"The idea of the accuracy and potential shorter surgery really appeals to patients when I tell them about the robotic technology," says Dr. Lim. "I tell them I'm about 90 percent accurate without the robot, but 10 percent of the time I wish the implant position was a little better. But with the robotic technology, I'm 99 percent accurate. I have the three-dimensional imaging to pre-plan the implant placement, so the intraoperative time is shorter and there is less room for human error."
A second consideration for spine surgeons — and operating room staff — is radiation exposure. Minimally invasive spine surgery traditionally exposes surgeons and OR staff to high radiation levels, but the robotic technology largely replaces fluoroscopy in the operating room and the high radiation levels.
"I definitely think robotic technology will be the standard in the future," says Dr. Lim. "One of the reasons why it isn't widely adopted now is because most surgeons are creatures of habit and conservative by nature; they like to employ medicines and techniques that are tried and true. With surgeons, especially spine surgeons, there is also some ego involved. They've had good results for decades, so why change? But surgeons being trained right now are driven to use new technologies and once you have generations of surgeons exposed to robotic technology, it will become the standard."
Even though Dr. Lim's patients generally like the idea of robotic technology, it's not driving patient volume at his practice; the patients aren't coming to him because of the robot. Without patient demand, surgeons don't feel pressure to use it and in term aren't demanding hospitals to purchase the technology.
The technology's future could depend on many different factors within spine surgery, as well as the larger healthcare system in general.
"I don't think whether we use robotic technology or not will make or break the healthcare system when it comes to spine surgery," says Dr. Lim. "I think the government and insurance companies will slowly remove the financial incentive for surgeons to operate on patients. Today surgeons are paid more for doing surgery than just seeing patients, but slowly we'll transition and I think the majority of elective spinal fusions won't be done. That's where the cost-savings will occur. But the remaining surgeries that are done will be more necessary and emphasize accuracy, which is where the new technology comes in."