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Index surgery and ninety day re-operation cost comparison of robotic-assisted versus manual total knee arthroplasty

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Abstract

Introduction

This study looks to compare early costs of index surgery and re-operations of robotic-assisted total knee arthroplasties (rTKA) and manual total knee arthroplasty (mTKA) re-operations within 90 days.

Material and methods

The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database was queried for patients undergoing rTKA and mTKA at our institution from January 1st, 2018, to March 31st, 2021. Primary outcomes were the day of surgery and overall encounter variable direct costs (VDC). Secondary outcomes included 90-day re-operations and costs.

Results

One thousand two hundred seventy-six (21.2%) patients were in the rTKA cohort, while 4740 (78.8%) were in the mTKA cohort. When comparing rTKA to mTKA, rTKA had higher median total encounter costs (p < 0.001) and higher encounter VDC costs (p < 0.001). TKA had higher day of surgery total VDC (p < 0.001), VDC supplies (p < 0.001), and VDC of post-op recovery (p < 0.001). Multivariate linear regression showed no relationship with age, BMI, OR time, or LOS with cost for rTKA or mTKA.

Conclusion

Results from our study show that rTKA is associated with a higher index surgery costs, and no difference in 90-day re-operation costs. The main factor driving increased cost is supply cost, with other variables between too small in difference to make a significant financial impact. Future studies should focus on post-operative costs including readmission and episode of care costs and should consider cost to the payor as opposed to VDC. rTKA will become more common, and other institutions may need to take a closer financial look at this more novel instrumentation before adoption.

Level of evidence: III, retrospective cohort

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Data Availability

De-identified data and statistics are available upon request.

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Acknowledgements

Pamela Bucki, Director of Finance and Support

Jason Hafron MD, Michigan Institute of Urology, William Beaumont School of Medicine, Beaumont Health

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Authors and Affiliations

  1. Oakland University William Beaumont School of Medicine, Rochester, MI, USA

    Ekene Uchenna Ezeokoli, Jithin John & Rohun Gupta

  2. Department of Orthopaedic Surgery, Beaumont Health Systems, Royal Oak, MI, USA

    Ali Jawad & Leonardo Cavinatto

Authors
  1. Ekene Uchenna Ezeokoli
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  2. Jithin John
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  3. Rohun Gupta
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  4. Ali Jawad
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Contributions

All authors whose names appear on the submission:

1.)Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work

2.)Drafted the work or revised it critically for important intellectual content

3.)Approved the version to be published

4.)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

Corresponding author

Correspondence to Ekene Uchenna Ezeokoli.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Beaumont Health institutional review board (IRB, 2021–122) on 7/1/19.

Consent for publication

As this was a retrospective chart review with minimal risk, the need to obtain individual consents was waived by the institutional review board.

Competing interests

The authors declare no competing interests.

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Ezeokoli, E.U., John, J., Gupta, R. et al. Index surgery and ninety day re-operation cost comparison of robotic-assisted versus manual total knee arthroplasty. International Orthopaedics (SICOT) 47, 359–364 (2023). https://doi.org/10.1007/s00264-022-05674-w

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  • DOI: https://doi.org/10.1007/s00264-022-05674-w

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