https://orcid.org/0000-0002-5901-1156
![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
ABSTRACT
Introduction
The impact of robotic-assisted total knee arthroplasty (rTKA) vs. traditional, manual TKA (mTKA) on hospital costs is not well documented and is analyzed herein.
Research Design and Methods
Patients in the Premier billing Healthcare Database undergoing elective rTKA or mTKA (“index’) in the in- or outpatient setting for knee osteoarthritis between Oct 1st, 2015, to September 30th, 2021, were identified. Variables included patient demographics and comorbidities and hospital characteristics. Matched rTKA vs. mTKA cohorts were created using direct (on provider characteristics, age, gender, race and Elixhauser index) and propensity score matching (fixation type, comorbidities). Index and 90-day inflation-adjusted costs and healthcare utilization (HCU) were analyzed for both cohorts, using generalized linear models.
Results
16,714 rTKA patients were matched to 51,199 mTKA patients. Average 90-day hospital cost reached $17,932 and were equivalent for both cohorts (rTKA vs. mTKA: $132 (95% confidence interval; -$19 to $284). There was a 2.7% (95%CI: 2.2%-3.3%) increase in home or home health discharge, and a 0.4% (95%CI: 0%-0.8%) decrease in 90-day hospital knee related re-visit in the rTKA vs. mTKA group.
Conclusions
Cost-neutrality of rTKA vs. mTKA was observed, with a potential for lowered immediate post-operative HCU in the rTKA vs. mTKA cohorts.
Acknowledgments
The authors thank Natalie Edwards of Health Services Consulting Corporation, Boxborough, MA, USA for editorial assistance with the manuscript and Anshu Gupta of Johnson and Johnson, NJ, USA for re-doing the analysis to address reviewers’ comments.
Declaration of interest
LG, ASC, KM, AG, CEH and DH are employees of Johnson & Johnson (JnJ) and own stock in the company and participated in the design of the study and in the collection, analysis, and interpretation of the data and in the writing the manuscript. SK was a contractor with JnJ at the time of the study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Reviewers Disclosure
Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.
IRB Approval
The use of Premier Healthcare Database was reviewed by the New England Institutional Review Board (IRB) and was determined to be exempt from broad IRB approval, as this research project did not involve human subject research and used data from an anonymous, de-identified, administrative claims database compliant with the Health Insurance Portability and Accountability Act of 1996.
Availability of Data and Materials
The data for these analyses were made available to the authors by third-party licenses from PREMIER (https://products.premierinc.com/applied-sciences/solutions/applied-research-and-analytics), a data provider in the US. Under the licensing agreement, the authors cannot provide raw data themselves. Other researchers could access the data by purchase through PREMIER, and the inclusion criteria specified in the Methods section would allow them to identify the same cohort of patients we used for these analyses.
Author’s Contributions
TBA, ASC, CEH, AG, KM, DPH and LG participated in the design of the study and in the collection, analysis, and interpretation of the data and in the writing the manuscript. KS, AG and CEH completed all programming for the research. TBA and DPH co-led the study design, reviewed all the data analyses and clinical interpretation, and led the final manuscript preparation.
Supplementary Material
Supplemental data for this article can be accessed online at https://doi.org/10.1080/17434440.2023.2185135