Subscribe to RSS
DOI: 10.1055/s-0039-1695741
Health Care Utilization and Payer Cost Analysis of Robotic Arm Assisted Total Knee Arthroplasty at 30, 60, and 90 Days
Abstract
This study performed a health care utilization analysis between robotic arm assisted total knee arthroplasty (rTKA) and manual total knee arthroplasty (mTKA) techniques. Specifically, we compared (1) index costs and (2) discharge dispositions, as well as (3) 30-day (4) 60-day, and (5) 90-day (a) episode-of-care costs, (b) postoperative health care utilization, and (c) readmissions. The 100% Medicare Standard Analytical Files were used for rTKAs and mTKAs performed between January 1, 2016, and March 31, 2017. Based on strict inclusion–exclusion criteria and 1:5 propensity score matching, 519 rTKA and 2,595 mTKA patients were analyzed. Total episode payments, health care utilization, and readmissions, at 30-, 60-, and 90-day time points were compared using generalized linear model, binomial regression, log link, Mann–Whitney, and Pearson's chi-square tests. The rTKA versus mTKA cohort average total episode payment was US$17,768 versus US$19,899 (p < 0.0001) at 30 days, US$18,174 versus US$20,492 (p < 0.0001) at 60 days, and US$18,568 versus US$20,960 (p < 0.0001) at 90 days. At 30 days, 47% fewer rTKA patients utilized skilled nursing facility (SNF) services (13.5 vs. 25.4%; p < 0.0001) and had lower SNF costs at 30 days (US$6,416 vs. US$7,732; p = 0.0040), 60 days (US$6,678 vs. US$7,901, p = 0.0072), and 90 days (US$7,201 vs. US$7,947, p = 0.0230). rTKA patients also utilized fewer home health visits and costs at each time point (p < 0.05). Additionally, 31.3% fewer rTKA patients utilized emergency room services at 30 days postoperatively and had 90-day readmissions (5.20 vs. 7.75%; p = 0.0423). rTKA is associated with lower 30-, 60-, and 90-day postoperative costs and health care utilization. These results are of marked importance given the emphasis to contain and reduce health care costs and provide initial economic insights into rTKA with promising results.
Publication History
Received: 12 April 2019
Accepted: 15 July 2019
Article published online:
02 September 2019
© 2019. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Khlopas A, Sodhi N, Sultan AA, Chughtai M, Molloy RM, Mont MA. Robotic arm-assisted total knee arthroplasty. J Arthroplasty 2018; 33 (07) 2002-2006
- 2 Marchand RC, Sodhi N, Anis HK. et al. One-year patient outcomes for robotic-arm-assisted versus manual total knee arthroplasty. J Knee Surg 2019; (e-pub ahead of print) DOI: 10.1055/s-0039-1683977.
- 3 Khlopas A, Sodhi N, Hozack WJ. et al. Patient-reported functional and satisfaction outcomes after robotic-arm-assisted total knee arthroplasty: early results of a prospective multicenter investigation. J Knee Surg 2019; (e-pub ahead of print). DOI: 10.1055/s-0039-1684014.
- 4 Sodhi N, Khlopas A, Ehiorobo JO. et al. Robotic-assisted total knee arthroplasty in the presence of extra-articular deformity. Surg Technol Int 2019; 34: 497-502
- 5 Sultan AA, Samuel LT, Khlopas A. et al. Robotic-arm assisted total knee arthroplasty more accurately restored the posterior condylar offset ratio and the Insall-Salvati index compared to the manual technique; a cohort-matched study. Surg Technol Int 2019; 34: 409-413
- 6 Cool CL, Jacofsky DJ, Seeger KA, Sodhi N, Mont MA. A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty. J Comp Eff Res 2019; 8 (05) 327-336
- 7 Bhowmik-Stoker M, Scholl L, Khlopas A. et al. Accurately predicting total knee component size without preoperative radiographs. Surg Technol Int 2018; 33: 337-342
- 8 Marchand RC, Sodhi N, Bhowmik-Stoker M. et al. Does the robotic arm and preoperative CT planning help with 3D intraoperative total knee arthroplasty planning?. J Knee Surg 2019; 32 (08) 742-749
- 9 Khlopas A, Chughtai M, Hampp EL. et al. Robotic-arm assisted total knee arthroplasty demonstrated soft tissue protection. Surg Technol Int 2017; 30: 441-446
- 10 Hampp EL, Chughtai M, Scholl LY. et al. Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques. J Knee Surg 2019; 32 (03) 239-250
- 11 Sultan AA, Piuzzi N, Khlopas A, Chughtai M, Sodhi N, Mont MA. Utilization of robotic-arm assisted total knee arthroplasty for soft tissue protection. Expert Rev Med Devices 2017; 14 (12) 925-927
- 12 Urish KL, Conditt M, Roche M, Rubash HE. Robotic total knee arthroplasty: surgical assistant for a customized normal kinematic knee. Orthopedics 2016; 39 (05) e822-e827
- 13 Marchand RC, Sodhi N, Khlopas A. et al. Coronal correction for severe deformity using robotic-assisted total knee arthroplasty. J Knee Surg 2018; 31 (01) 2-5
- 14 Sodhi N, Khlopas A, Piuzzi NS. et al. Erratum to: the learning curve associated with robotic total knee arthroplasty. J Knee Surg 2018; 31 (04) 370
- 15 Marchand RC, Sodhi N, Khlopas A. et al. Patient satisfaction outcomes after robotic arm-assisted total knee arthroplasty: a short-term evaluation. J Knee Surg 2017; 30 (09) 849-853
- 16 Kayani B, Konan S, Tahmassebi J, Pietrzak JRT, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone Joint J 2018; 100-B (07) 930-937
- 17 McLawhorn AS, Buller LT. Bundled payments in total joint replacement: keeping our care affordable and high in quality. Curr Rev Musculoskelet Med 2017; 10 (03) 370-377
- 18 Pearle AD, van der List JP, Lee L, Coon TM, Borus TA, Roche MW. Survivorship and patient satisfaction of robotic-assisted medial unicompartmental knee arthroplasty at a minimum two-year follow-up. Knee 2017; 24 (02) 419-428
- 19 Perets. et al. Robot-assisted total hip arthroplasty: Clinical outcomes and complication rate. Int J Med Robotics Comput Assist Surg 2018; 1-8
- 20 Morgan L. US healthcare annual spending estimated to rise by 5.8% on average through 2024. Am Health Drug Benefits 2015; 8 (05) 272
- 21 Kayani B, Konan S, Pietrzak JRT, Haddad FS. Iatrogenic bone and soft tissue trauma in robotic-arm assisted total knee arthroplasty compared with conventional jig-based total knee arthroplasty: a prospective cohort study and validation of a new classification system. J Arthroplasty 2018; 33 (08) 2496-2501
- 22 Sibia US, Mandelblatt AE, Callanan MA, MacDonald JH, King PJ. Incidence, risk factors, and costs for hospital returns after total joint arthroplasties. J Arthroplasty 2017; 32 (02) 381-385
- 23 Kelly MP, Prentice HA, Wang W, Fasig BH, Sheth DS, Paxton EW. Reasons for ninety-day emergency visits and readmissions after elective total joint arthroplasty: results from a US integrated healthcare system. J Arthroplasty 2018; 33 (07) 2075-2081