Journal Article

A Cost Analysis of Traditional Versus Robotic Total Knee Arthroplasty Performed With an Imageless, Second-generation Robotic System

Cochrane, Niall H., Hallows, Rhett, Leal, Justin, Kim, Billy I., Holland, Christopher T., Seyler, Thorsten

2024

Overview

Background This study compared perioperative outcomes as well as encounter and 90-day costs between patients undergoing traditional vs robotic total knee arthroplasty (rTKA). Materials and Methods A total of 430 TKAs (215 rTKAs, 215 traditional) were retrospectively reviewed. All rTKAs were performed with an imageless, second-generation robotic system. Cohorts were propensity score matched by age, sex, body mass index, and American Society of Anesthesiologists score. Perioperative data and 90-day complications were subsequently compared. Cox regression analyses evaluated survival to all-cause revisions. Univariable analyses compared total cost of care for the initial encounter and 90-day postoperative period. Multivariable regression analyses were then performed to evaluate associations with increased encounter and 90-day costs. Results Patients undergoing rTKA had a higher incidence of discharge home (86.5% vs 60.0%; P<.001). The rTKA cohort trended toward a lower incidence of 90-day emergency department visits, and there was a significantly lower percentage of 90-day readmissions (4.2% vs 13.5%; P=.001). Cox hazard ratio demonstrated no difference in survival to all-cause revisions (hazard ratio, 1.3; 95% CI, 0.5–3.7; P=.64). The cost of surgery was significantly higher in the rTKA cohort ($9292 vs $8392; P<.001); however, there was no difference in cost of encounter ($10,356.86 vs $10,396.44; P=.110) or at 90 days postoperatively ($11,103.89 vs $11,040.13; P=.739). rTKA did not have a significant association with increased cost at 90 days postoperatively (odds ratio, 0.96; 95% CI, 0.90–1.02; P=.180). Conclusion rTKA had a higher intraoperative cost compared with traditional TKA. However, with increased home discharges and fewer 90-day readmissions, rTKA was not associated with increased cost at 90 days. [Orthopedics. 2024;47(6):365–371.]

• Publisher: SLACK Incorporated,Slack, Inc,SLACK INCORPORATED
• Subject: Aged / Anesthesia / Arthroplasty, Replacement, Knee - economics / Arthroplasty, Replacement, Knee - instrumentation / Arthroplasty, Replacement, Knee - methods / Body mass index / Cost analysis / Cost benefit analysis / Cost reduction / Costs and Cost Analysis / Demographics / Dosage and administration / Emergency medical care / Female / Fractures / Health aspects / Hospitals / Humans / Joint replacement surgery / Length of stay / Male / Medical personnel / Methods / Middle Aged / Patients / Postoperative Complications - economics / Postoperative Complications - epidemiology / Postoperative period / Regression analysis / Retrospective Studies / Robotic surgery / Robotic Surgical Procedures - economics / Robotics / Surgeons / Surgical outcomes / Tranexamic acid