Robotic versus conventional single-level lumbar fusion in frail older adults

Background: Lumbar fusion is a common intervention for degenerative spinal conditions, with robotic-assisted techniques offering improved precision. However, evidence comparing robotic and conventional fusion in frail older adults is limited. This study evaluated short-term postoperative outcomes in this high-risk population. Materials and methods: This retrospective study analyzed data from frail adults aged ≥ 60 years who underwent single-level lumbar fusion between 2016 and 2020 using the National Readmission Database. Frailty was assessed with the Hospital Frailty Risk Score (HFRS). Outcomes—including in-hospital mortality, complications, hospital charges, and length of stay (LOS)—were compared between robotic and conventional fusion groups using propensity score matching (PSM). Key covariates used in the matching process included age and severe liver disease. Logistic regression provided adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: Among 29,938 patients identified, 20,227 met inclusion criteria, and 3135 patients remained after PSM. Robotic surgery was associated with significantly higher hospital charges compared with the conventional approach (mean 203,700 USD versus 151,200 USD; β = 52.51, 95% CI 26.41, 78.60; p < 0.001). No significant differences were observed in in-hospital mortality (0.4% for both; OR 1.03, 95% CI 0.14, 7.79, p = 0.978), LOS (5.3 versus 5.6 days; β = −0.36, p = 0.263), or complication rates between groups. Conclusions: Robotic-assisted lumbar fusion in frail older adults leads to higher total hospital charges without short-term clinical benefit compared with conventional techniques. Further research is needed to assess long-term outcomes and justify the use of robotic surgery in this population.