Bernstein Jenna, Gupta Anshu, Kabiri Mina, Ruppenkamp Jill W, Goldstein Laura, Diaz Rodrigo
From the Connecticut Orthopaedics, Fairfield, CT (Dr. Bernstein); the Epidemiology and Real-World Data Sciences, Johnson & Johnson MedTech, New Brunswick, NJ (Dr. Gupta and Ruppenkamp); the Global Health Economics and Market Access, Johnson & Johnson MedTech, Raynham, MA (Dr. Kabiri and Goldstein); and the Medical Affairs, Johnson & Johnson MedTech, Palm Beach Gardens, FL (Dr. Diaz).
J Am Acad Orthop Surg Glob Res Rev. 2024 Dec 23;8(12). doi: 10.5435/JAAOSGlobal-D-24-00324. eCollection 2024 Dec 1.
Computer-assisted fluoroscopic navigation and robotic technologies aim to optimize implant placement and alignment in primary total hip arthroplasty (THA) to improve patient outcomes. This study uses a retrospective hospital billing database covering 1,300 hospitals to compare the clinical and economic effect of these technologies.
The study compared patients undergoing THA with robotic versus computer-assisted fluoroscopic navigation technologies between January 1, 2016, and September 30, 2021, using the Premier Healthcare Database. Primary outcomes were operating room time and readmission rates. Secondary outcomes were length of stay, discharge status, revision rates within 90- and 365-day follow-up, and hospital costs. Baseline covariate differences between the two cohorts were balanced using fine stratification methodology and analyzed using generalized linear models. A sensitivity analysis was conducted using the nearest neighbor matching as the covariate balancing technique.
The cohorts included 4,378 fluoroscopically navigated THA and 10,423 robotic-assisted THA procedures with 90-day follow-up. Operating room time was markedly lower with fluoroscopic navigation compared with robotic-assisted technology (137.74 vs. 156.00 minutes; P < 0.001). Hip-related readmission rates were markedly lower (P < 0.001) for fluoroscopic navigation for both 90- and 365-day follow-up, by 43% and 40% respectively, compared with robotic-assisted technology. Results showed increased discharge ratio to home/home health, reduced length of stay, and lower hospital costs for fluoroscopic navigation compared with robotic-assisted technology. Revision rates were similar for both cohorts.
Using computer-assisted fluoroscopic navigation in THA was associated with markedly lower operating room time and readmission rates while also having improved healthcare outcomes and costs compared with robotic-assisted technology.
计算机辅助荧光透视导航和机器人技术旨在优化初次全髋关节置换术（THA）中植入物的放置和对齐，以改善患者预后。本研究使用覆盖1300家医院的回顾性医院计费数据库，比较这些技术的临床和经济效果。
该研究使用Premier医疗数据库，比较了2016年1月1日至2021年9月30日期间接受机器人辅助与计算机辅助荧光透视导航技术进行THA的患者。主要结局为手术时间和再入院率。次要结局为住院时间、出院状态、90天和365天随访内的翻修率以及医院费用。使用精细分层方法平衡两个队列之间的基线协变量差异，并使用广义线性模型进行分析。使用最近邻匹配作为协变量平衡技术进行敏感性分析。
队列包括4378例接受荧光透视导航的THA和10423例机器人辅助的THA手术，并进行了90天随访。与机器人辅助技术相比，荧光透视导航的手术时间明显更短（137.74分钟对156.00分钟；P<0.001）。在90天和365天随访中，荧光透视导航的髋关节相关再入院率均明显更低（P<0.001），分别比机器人辅助技术低43%和40%。结果显示，与机器人辅助技术相比，荧光透视导航的回家/家庭健康出院率更高、住院时间更短且医院成本更低。两个队列的翻修率相似。
在THA中使用计算机辅助荧光透视导航与明显更短的手术时间和再入院率相关，同时与机器人辅助技术相比，还改善了医疗结局并降低了成本。
