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

4 pagesPublished: October 27, 2019

Abstract

Introduction
This study performed a healthcare utilization analysis between robotic-arm assisted and manual TKA techniques at three intervals to better understand intra-episode trends that can lead to optimized care pathways. Specifically, we compared: (1) index costs; and (2) discharge dispositions; as well as (3) 30-; (4) 60-; and (5) 90- day: a) total episode-of-care costs, b) post-operative healthcare utilization, and c) readmissions.

Methods
The Medicare 100% Standard Analytical Files was queried for robotic and manual TKAs (rTKA and mTKA) performed between January 1, 2016 and March 31, 2017. Based on strict inclusion and exclusion criteria, and 1:5 propensity score matching, 519 robotic and 2,595 manual TKA patients were analyzed. Total episode payments, healthcare utilization, and readmissions, at 30-, 60-, and 90-day time points were compared between cohorts with a generalized Linear Model, Binomial Regression, log link, Mann-Whitney, and Pearson's Chi Squared tests with p<0.05 for statistical significance.

Results
The robotic vs. manual cohort average total episode payment was $17,768 vs. $19,899 (p<0.0001) at 30-days; $18,174 vs. $20,492 (p<0.0001) at 60-days; and $18,568 vs. $20,960 (p<0.0001) at 90-days. At 30 days, 47% fewer rTKA patients utilized SNF services (13.5 vs. 25.4%, p<0.0001 and had lower SNF costs at 30- ($6,416 vs. $7,732; p = 0.0040), 60- ($6,678 vs. $7,901, p=0.0072), and 90-days ($7,201 vs. $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. The robotic cohort had significantly fewer 90-day readmissions (5.20 vs. 7.75%; p=0.0423).

Discussion
Robotic TKA is associated with significantly lower 30-, 60-, and 90-day post- operative costs and healthcare utilization. These results are of marked importance given the emphasis to contain and reduce healthcare costs for total joints arthroplasties. This analysis provides initial economic insight into robotic-arm assisted TKA with promising results.

Keyphrases: cost analysis, Healthcare economics, new technologies, Robotic-arm assisted TKA, TKA

In: Patrick Meere and Ferdinando Rodriguez Y Baena (editors). CAOS 2019. The 19th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 3, pages 72--75

Links:
BibTeX entry
@inproceedings{CAOS2019:Healthcare_Utilization_and_Payer,
  author    = {Andrea Coppolecchia and Christina Cool and David Jacofsky and David Gregory and Nipun Sodhi and Michael Mont},
  title     = {Healthcare Utilization and Payer Cost Analysis of Robotic-Arm Assisted Total Knee Arthroplasty at 30-, 60-, and 90-Days},
  booktitle = {CAOS 2019. The 19th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery},
  editor    = {Patrick Meere and Ferdinando Rodriguez Y Baena},
  series    = {EPiC Series in Health Sciences},
  volume    = {3},
  pages     = {72--75},
  year      = {2019},
  publisher = {EasyChair},
  bibsource = {EasyChair, https://easychair.org},
  issn      = {2398-5305},
  url       = {https://easychair.org/publications/paper/LZMc},
  doi       = {10.29007/zdrl}}
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