Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York.
Hospital and Health, Baker Tilly Virchow Krause LLP, Madison, Wisconsin.
J Knee Surg. 2021 Feb;34(3):328-337. doi: 10.1055/s-0039-1695741. Epub 2019 Sep 2.
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 ( < 0.0001) at 30 days, US$18,174 versus US$20,492 ( < 0.0001) at 60 days, and US$18,568 versus US$20,960 ( < 0.0001) at 90 days. At 30 days, 47% fewer rTKA patients utilized skilled nursing facility (SNF) services (13.5 vs. 25.4%; < 0.0001) and had lower SNF costs at 30 days (US$6,416 vs. US$7,732; = 0.0040), 60 days (US$6,678 vs. US$7,901, = 0.0072), and 90 days (US$7,201 vs. US$7,947, = 0.0230). rTKA patients also utilized fewer home health visits and costs at each time point ( < 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%; = 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.
本研究对机器人辅助全膝关节置换术（rTKA）和手动全膝关节置换术（mTKA）技术的医疗保健利用情况进行了分析。具体来说，我们比较了（1）指数成本和（2）出院情况，以及（3）30 天（4）60 天和（5）90 天（a）治疗周期成本、（b）术后医疗保健利用情况和（c）再入院率。使用 100%的医疗保险标准分析文件对 2016 年 1 月 1 日至 2017 年 3 月 31 日期间进行的 rTKA 和 mTKA 进行了分析。基于严格的纳入排除标准和 1:5 的倾向评分匹配，分析了 519 例 rTKA 和 2595 例 mTKA 患者。使用广义线性模型、二项式回归、对数链接、曼-惠特尼和皮尔逊卡方检验比较了 30、60 和 90 天时间点的总治疗周期支付、医疗保健利用情况和再入院率。rTKA 与 mTKA 队列的平均总治疗周期支付分别为 30 天时的 17768 美元和 19899 美元（ < 0.0001）、60 天时的 18174 美元和 20492 美元（ < 0.0001），以及 90 天时的 18568 美元和 20960 美元（ < 0.0001）。在 30 天时，rTKA 患者接受熟练护理机构（SNF）服务的比例降低了 47%（13.5% vs. 25.4%； < 0.0001），SNF 费用也降低了（30 天时的 6416 美元 vs. 7732 美元； = 0.0040），60 天时的 6678 美元 vs. 7901 美元， = 0.0072），90 天时的 7201 美元 vs. 7947 美元， = 0.0230）。rTKA 患者在每个时间点的家庭健康访问次数和费用也更少（ < 0.05）。此外，rTKA 患者在术后 30 天接受急诊服务的比例降低了 31.3%，90 天的再入院率也降低了（5.20% vs. 7.75%； = 0.0423）。rTKA 与术后 30、60 和 90 天的较低成本和医疗保健利用率相关。鉴于控制和降低医疗保健成本的重点以及对 rTKA 具有前景的初步经济见解，这些结果具有重要意义。
