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Published on: May 20, 2018
The Importance of Surgeon Dashboarding for Comparative Quality and Safety Outcomes when Adopting Robotics in Practice
Alexa P Bosco1, Nicole W Welch1, Margaret L Sullivan1
1Boston Children's Hospital, Department of Orthopaedic Surgery, Boston, MA.
Study Design:
Retrospective Cohort Study.
Objective:
To characterize the utility and value of surgical dashboarding when adopting robotic technology into surgical practice.
Summary Of Background Data:
The adoption of robotics assisted with navigation (RAN) for pedicle screw placement in adolescent idiopathic scoliosis (AIS) has shown similar intraoperative performance and safety profile when compared to freehand (FH) technique. Prospectively enrolling patients in the Surgeon Performance Program (SPP) Quality Improvement Registry allows surgeons to identify areas for improvement and analyze performance individually or compared to peers. This study employs SPP dashboarding metrics to compare quality and safety outcomes using RAN versus FH in AIS surgery in AIS patients who underwent posterior spinal fusion by a single surgeon from 2016-2022.
Methods:
Demographics and radiographs were summarized with descriptive statistics. Surgical measures, radiographic outcomes, and complications from the SPP were compared between RAN and FH groups and against national means using t-tests, Wilcoxon tests, Fisher's exact tests, and chi-squared tests as appropriate.
Results:
The cohort included 215 patients (121 FH, 94 RAN), had a mean age of 15.3 years and was mostly female (82%). Demographics and preoperative radiographic measures did not differ between groups. Dashboarding revealed RAN had significantly longer mean surgical time (240 mins vs. 192 mins; P<0.001) and higher curve correction (70% vs. 60%; P=0.003) than FH patients. There were no differences in complication rates (P=0.3) or EBL (P=0.4) found between RAN and FH. Compared to national averages, quartiles for surgical time, EBL, and complications were the same for each group. There were no deep infections, neurologic deficits, or return to OR for malpositioned screws in either group.
Conclusions:
SPP dashboarding results effectively compared RAN and FH techniques in spinal surgery, revealing increased surgical time but higher curve correction in RAN patients, but comparable EBL and safety profiles across groups.
