Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157 Camperdown, Sydney, NSW, 2050, Australia.
Orthopaedic Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
J Robot Surg. 2024 May 8;18(1):206. doi: 10.1007/s11701-024-01932-8.
As uptake of robotic-assisted arthroplasty increases there is a need for economic evaluation of the implementation and ongoing costs associated with robotic surgery. The aims of this study were to describe the in-hospital cost of robotic-assisted total knee arthroplasty (RA-TKA) and robotic-assisted unicompartmental knee arthroplasty (RA-UKA) and determine the influence of patient characteristics and surgical outcomes on cost. This prospective cohort study included adult patients (≥ 18 years) undergoing primary unilateral RA-TKA and RA-UKA, at a tertiary hospital in Sydney between April 2017 and June 2021. Patient characteristics, surgical outcomes, and in-hospital cost variables were extracted from hospital medical records. Differences between outcomes for RA-TKA and RA-UKA were compared using independent sample t-tests. Logistic regression was performed to determine drivers of cost. Of the 308 robotic-assisted procedures, 247 were RA-TKA and 61 were RA-UKA. Surgical time, time in the operating room, and length of stay were significantly shorter in RA-UKA (p < 0.001); whereas RA-TKA patients were older (p = 0.002) and more likely to be discharged to in-patient rehabilitation (p = 0.009). Total in-hospital cost was significantly higher for RA-TKA cases (AU$18580.02 vs $13275.38; p < 0.001). Robotic system and maintenance cost per case was AU$3867.00 for TKA and AU$5008.77 for UKA. Patients born overseas and lower volume robotic surgeons were significantly associated with higher total cost of RA-UKA. Increasing age and male gender were significantly associated with higher total cost of RA-TKA. Total cost was significantly higher for RA-TKA than RA-UKA. Robotic system costs for RA-UKA are inflated by the software cost relative to the volume of cases compared with RA-TKA. Cost is an important consideration when evaluating long term benefits of robotic-assisted knee arthroplasty in future studies to provide evidence for the economic sustainability of this practice.
随着机器人辅助关节置换术的应用增加，需要对与机器人手术相关的实施和持续成本进行经济评估。本研究的目的是描述机器人辅助全膝关节置换术（RA-TKA）和机器人辅助单髁膝关节置换术（RA-UKA）的住院成本，并确定患者特征和手术结果对成本的影响。这项前瞻性队列研究纳入了 2017 年 4 月至 2021 年 6 月期间在悉尼一家三级医院接受初次单侧 RA-TKA 和 RA-UKA 的成年患者（≥18 岁）。从医院病历中提取患者特征、手术结果和住院成本变量。使用独立样本 t 检验比较 RA-TKA 和 RA-UKA 的结果差异。使用逻辑回归确定成本的驱动因素。在 308 例机器人辅助手术中，247 例为 RA-TKA，61 例为 RA-UKA。RA-UKA 的手术时间、手术室时间和住院时间明显更短（p<0.001）；而 RA-TKA 患者年龄更大（p=0.002），更有可能被转至住院康复治疗（p=0.009）。RA-TKA 病例的总住院费用明显更高（AU$18580.02 比 AU$13275.38；p<0.001）。每例机器人系统和维护费用分别为 TKA 的 AU$3867.00 和 UKA 的 AU$5008.77。出生在海外的患者和机器人手术量较低的外科医生与 RA-UKA 的总费用显著相关。年龄增加和男性与 RA-TKA 的总费用显著相关。RA-TKA 的总费用明显高于 RA-UKA。与 RA-TKA 相比，RA-UKA 的机器人系统成本因软件成本相对于病例数量而膨胀。在未来的研究中，当评估机器人辅助膝关节置换术的长期效益时，成本是一个重要的考虑因素，以便为这种实践的经济可持续性提供证据。
