Trends and outcomes of robot-assisted internal fixation for pelvic fractures: a nationwide study

To analyze national utilization trends and compare perioperative outcomes of robotic-assisted (RA) versus non-robotic-assisted (NO-RA) open reduction and internal fixation (ORIF) for pelvic fractures. Patients with pelvic ring fractures who underwent internal fixation between 2016 and 2022 were identified using the National Inpatient Sample (NIS) database. Patients were stratified into RA (n = 356) and NO-RA (n = 19,813) cohorts. Propensity score matching (PSM) served to equilibrate the study groups with respect to baseline variables (age, sex, race, and comorbidity burden). The primary clinical endpoints included in-hospital all-cause mortality, LOS, and perioperative complications. A total of 20,169 weighted cases were identified. Notably, the utilization of RA internal fixation (RA-IF) increased from 0.7% in 2016 to 2.7% in 2022. The RA cohort was significantly older (median of 56 vs. 44 years, P < 0.001) and had a higher burden of comorbidities compared to the unmatched NO-RA group. Following 1:2 PSM (356 RA vs. 712 NO-RA), RA-IF was associated with markedly higher total hospital charges ($192,250 vs. $144,174; P < 0.001) and a longer median LOS (9 vs. 7 days; P < 0.05). Multivariate logistic regression in the matched cohorts showed that the RA cohort had a higher risk of nerve injury (OR 2.651, 95% CI 1.443-4.873; P = 0.002). However, the two cohorts were comparable with respect to sepsis, deep vein thrombosis, pneumonia, or injury to the urinary/pelvic organs (P > 0.05). The utilization of RA-IF for pelvic fractures has steadily increased in the United States. Although RA-IF was associated with higher hospital charges and longer LOS, it was more frequently utilized in older patients with a greater comorbidity burden. Of note, the analysis points to a potential association between RA-IF and increased incidence of certain surgical complications (e.g., nerve injury), during the early adoption phase. Nonetheless, further investigation into the learning curve and cost-effectiveness of this technology is warranted.