Redwood Orthopaedic Surgery Associates, Santa Rosa, CA.
Orthopaedic and Sports Medicine Institute, Providence Health, Renton, WA.
J Arthroplasty. 2022 Aug;37(8S):S782-S789. doi: 10.1016/j.arth.2021.12.018. Epub 2021 Dec 21.
Robotic-assisted total knee arthroplasty (RTKA) was introduced to improve surgical accuracy and patient outcomes. However, RTKA may also increase operating time and add cost to TKA. This study sought to compare the differences in cost and quality measures between manual TKA (MTKA) and RTKA METHODS: All MTKAs and RTKAs performed between January 1, 2017 and December 31, 2019, by 6 high volume surgeons in each cohort, were retrospectively reviewed. Cohorts were propensity score matched. Operative time, length of stay (LOS), total direct cost, 90-day complications, utilization of postacute services, and 30-day readmissions were studied.
After one-to-one matching, 2392 MTKAs and 2392 RTKAs were studied. In-room/out-of-room operating time was longer for RTKA (139 minutes) than for MTKA (107 minutes) P < .0001, as was procedure time (RTKA 78 minutes; MTKA 70 minutes), P < .0001. Median LOS was equal for MTKA and RTKA (33 hours). Total cost per case was greater for RTKA ($11,615) than MTKA ($8674), P < .0001. Home health care was utilized more frequently after RTKA (38%) than MTKA (29%), P < .0001. There was no significant difference in 90-day complication rates. Thirty-day readmissions occurred more often after MTKA (4.9%) than RTKA (1.2%), P < .0001.
RTKA was a longer and costlier procedure than MTKA for experienced surgeons, without clinically significant differences in LOS or complications. Home health care was utilized more often after RTKA, but fewer readmissions occurred after RTKA. Longer term follow-up and functional outcome studies are required to determine if the greater cost of RTKA is offset by lower revision rates and/or improved functional results.
机器人辅助全膝关节置换术（RTKA）的引入是为了提高手术的准确性和患者的治疗效果。然而，RTKA 可能会增加手术时间，并增加 TKA 的成本。本研究旨在比较手动 TKA（MTKA）和 RTKA 的成本和质量指标差异。
回顾性分析了 2017 年 1 月 1 日至 2019 年 12 月 31 日期间由 6 位高容量外科医生在每个队列中进行的所有 MTKA 和 RTKA。对队列进行倾向评分匹配。研究了手术时间、住院时间（LOS）、总直接成本、90 天并发症、急性后服务利用情况和 30 天再入院率。
在一对一匹配后，共研究了 2392 例 MTKA 和 2392 例 RTKA。RTKA 的室内/室外手术时间（139 分钟）长于 MTKA（107 分钟），P<0.0001，手术时间也更长（RTKA 78 分钟；MTKA 70 分钟），P<0.0001。MTKA 和 RTKA 的 LOS 中位数相等（33 小时）。每例病例的总费用 RTKA 更高（11615 美元），MTKA 较低（8674 美元），P<0.0001。RTKA 后更常使用家庭保健（38%），MTKA 后更常使用（29%），P<0.0001。90 天并发症发生率无显著差异。MTKA（4.9%）的 30 天再入院率高于 RTKA（1.2%），P<0.0001。
对于经验丰富的外科医生来说，RTKA 是一种比 MTKA 更长、更昂贵的手术，但 LOS 或并发症没有临床显著差异。RTKA 后更常使用家庭保健，但 RTKA 后再入院率较低。需要进行更长期的随访和功能结果研究，以确定 RTKA 的更高成本是否可以通过较低的翻修率和/或改善的功能结果来抵消。
