Impact of surgical instrumentation on hospital length of stay and cost of total knee arthroplasty

ABSTRACT

Background

We aimed to analyze the impact of two different types of surgical instrumentation (conventional manual instrumentation (CI) and patient-specific instrumentation (PSI)) on length of stay (LOS) and objectify differences in cost. We hypothesized that there are no differences in the LOS and cost due to the instrumentation system used.

Research design and methods

LOS was registered using inpatient admission data provided by the Institutional Management Control Department. We recorded the costs associated with each procedure that could be influenced by the use of one system or another during the in-hospital stay. We conducted a prospectively single-center cohort study of 305 TKAs. Surgery was performed with conventional CI in 122 cases and with PSI in 183 cases.

Results

The mean LOS for the CI group was 4.29 days (SD 1.65) and 4.22 days (SD 1.26), for the PSI group. No significant difference among both instrumentation systems was obtained. When comparing global costs, the mean cost was slightly higher (without a significant difference) for the PSI cases (€3110.24 vs. €2852.7 for the CI cases).

Conclusions

LOS and overall cost, in hospitals with a low annual TKA surgery volume, are unrelated to conventional or patient-specific instrumentation.

KEYWORDS:

• Hospital length of stay
• patient-specific instrumentation
• surgical instrumentation
• total knee arthroplasty

Article highlights

• A strong correlation among LOS and the total cost of the TKA process exists, making the duration of hospitalization a priority item for cost control.

• As concerns PSI and decreasing LOS, there are discrepancies in the literature. Most studies have been performed in high-volume knee replacement institutions, and we ignore the impact of surgical instrumentation on LOS in hospitals with lower TKA surgery volume.

• If we consider the variables LOS and cost, there is no reason for not employing PSI in TKA surgery in institutions with a low annual volume of these procedures.

Acknowledgments

We thank Guadalupe Buitrago López, María Josefa Cantero Sánchez and Josefa Lucas García (Surgical Nurses of Hospital de la Vega Lorenzo Guirao; Murcia, Spain) for sharing data for use in the costs study and Manuel Canteras Jordana (Retired University Professor in the area of knowledge of “Preventive Medicine and Public Health” at the University of Murcia) for its invaluable assistance with statistical analysis.

Declarartion of interest

VLM has received honoraria for speaking at symposia and financial support from Medacta International SA to attend symposia and educational programs. 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Authors’ contributions

VLM made substantial contributions to the conception and the design of the work, performed the data collection, made substantial contributions to the analysis and interpretation of data for the work, and drafted the manuscript. MLL conceived of the study and participated in its design and coordination, helped to draft the manuscript, revised the manuscript critically, and made substantial contributions to the analysis and interpretation of data. FMM and FSM revised the manuscript critically and made substantial contributions to the analysis and interpretation of data and to the formal aspects of the manuscript. All the authors read and approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Additional information

Funding

No benefits or funds were received in support of the study.