The hidden cost of robotic spine surgery: real-world adverse events cause 58-minute delays and undermine economic viability.

Abstract

Robotic spine surgery has experienced substantial market growth with global projections exceeding $1.2 billion by 2026. Manufacturers prominently promote enhanced screw placement accuracy, reduced radiation exposure, and improved surgical efficiency as primary value propositions. To provide a comprehensive economic analysis incorporating the impact of adverse events on manufacturer claimed benefits. Cross-sectional study. This study included 1346 robotic spine surgery adverse events (812 MazorX and 534 Globus Excelsius) reported to the FDA Manufacturer and User Facility Device Experience (MAUDE) database from 2016 to 2025. Adverse event characterizations and procedural delay. Using a structured extraction methodology, we quantified procedural time impacts, workflow modifications, and resource utilization requirements associated with robotic complications. These measured parameters were subsequently incorporated into an economic model evaluating financial viability across 189 scenarios with varied operating room costs, annual case volumes, and complication rates. Adverse events resulted in a mean procedural delay of 58.1 minutes (95% CI, 54.7-61.5 minutes), with significant variation between robotic systems (Globus: 88.5 minutes vs. MazorX: 45.3 minutes; p<.001). Precision issues, despite representing the central marketing claim of robotic technology, constituted 66.4% of reported complications. Robot abandonment occurred in 34.4% of cases, resulting in significantly longer delays (71.4 vs. 44.8 minutes; p<.001). Economic analysis incorporating these measured disruptions demonstrated that none of the 189 modeled scenarios achieved financial breakeven within the systems' 7-year useful life, with even optimal conditions requiring 33.8 years to recover initial investment costs. Our findings highlight a disconnect between the marketed efficiency of robotic spine surgery and its observed economic and clinical realities. The increased procedural delays and predominance of precision-related adverse events suggest that current robotic platforms may require further refinement to align more closely with the operational needs of surgeons and the fiscal priorities of healthcare systems striving to balance innovation, quality, and value.