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J Knee Surg 2021; 34(03): 328-337
DOI: 10.1055/s-0039-1695741
Original Article

Health Care Utilization and Payer Cost Analysis of Robotic Arm Assisted Total Knee Arthroplasty at 30, 60, and 90 Days

Michael A. Mont
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
,
Christina Cool
2   Hospital and Health, Baker Tilly Virchow Krause LLP, Madison, Wisconsin
,
David Gregory
2   Hospital and Health, Baker Tilly Virchow Krause LLP, Madison, Wisconsin
,
Andrea Coppolecchia
3   Stryker Orthopaedics, Mahwah, New Jersey
,
Nipun Sodhi
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
,
David J. Jacofsky
4   Adult Reconstruction, The CORE Institute, Phoenix, Arizona
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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.

Keywords

economics - robotic TKA - reimbursement - health care reform


Publication History

Received: 12 April 2019

Accepted: 15 July 2019

Article published online:
02 September 2019

© 2019. Thieme. All rights reserved.

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  • 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
    CrossrefPubMedGoogle Scholar
  • 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.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 19 Perets. et al. Robot-assisted total hip arthroplasty: Clinical outcomes and complication rate. Int J Med Robotics Comput Assist Surg 2018; 1-8
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar