HCAHPS replaces Press Ganey survey as quality measure for patient hospital experience.

using conventional techniques. 2 Other retrospective reports have shown even higher accuracy with Devito et al reporting a 98.3% good placement (Gertzbein Robbins A and B) in 646 screws. 3 Interestingly they also reported a successful " execution rate " of the robot only ranging from 83% to 90% depending on where in the learning curve the cases were performed. The authors of the current study also highlight limitations of the system that may help explain the low accuracy provided by robotic assistance in this study. First, there are several techniques available to fixate the robot to the patient. In this study the authors utilized the " bed mount " option where the robot is only attached to the patient by a single K-wire which they speculate may allow for movement of the system relative to the patient. Furthermore all screws were placed through a paramedian, Wiltse-type approach with blunt perforation of the paraspinal musculature by the cannula. The authors note that with this technique any firm muscle bundles could lead to deflection of the cannula. Likewise facet joint hypertrophy with a steep facet can give rise to lateral skidding of the cannula at the pedicle screw entrance point. All of these factors may influence the accuracy of the system and should be considered when utilizing the system. In conclusion, the use of robotic assistance for pedicle screw placement has been gaining clinical acceptance in select sites throughout the United States and Europe. With this increased utilization the generation of outcome data has also been accumulating, albeit slowly. The study by Ringel is the first prospective randomized trial of the technology and indicates that, using the techniques employed in this trial, the robotic assistance led to significantly decreased pedicle screw placement accuracy. REFERENCES 1. Ringel F, Stuer C, Reinke A, et al. Accuracy of robot-assisted placement of lumbar and sacral pedicle screws: a prospective randomized comparison to conventional freehand screw implantation. course and accuracy of screw positioning in conventional, open robot-ic-guided and percutaneous robotic-guided, pedicle screw placement. Silberstein B, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. B eginning in just a few months, hospital patient satisfaction scores will have a direct impact on the bottom line for health care reimbursement. In October 2012, the Center for Medicare and Medicaid Services (CMS) is reducing by 1% the base operating diagnosis-related group …