Severson Erik, Tan Ziyu, English Adam, Reimer John, Goldstein Laura, Etter Katherine
Cuyuna Regional Medical Center, Crosby, MN, USA.
Value, Analytics and Evidence, HEMA, Johnson & Johnson, Raritan, NJ, USA.
J Robot Surg. 2025 Aug 31;19(1):539. doi: 10.1007/s11701-025-02510-2.
This study compared healthcare resource utilization associated with the use of VELYS™ Robotic-assisted solution (VRAS) vs. manual surgery for primary total knee arthroplasty (TKA).
Electronic medical records of patients undergoing TKA from a single surgeon at a US critical access hospital (manual surgery: 2019 to 2020; VRAS: 2022 to 2023) were reviewed. The primary clinical/health economic outcome of interest was pain medication use (morphine milligram equivalents [MMEs]). The secondary clinical/health economic outcome of interest was hospital length of stay (LOS). Multivariable logistic regression models accounted for potential confounding.
Among 452 TKA cases (mean [SD] age 67.4 [9.0] years, 50.2% male), 215 patients (47.6%) received VRAS and 237 (52.4%) received manual surgery. VRAS patients were slightly older (67.9 vs. 66.9 years) and a greater proportion were male (55.7 vs. 46.0%). Unadjusted analyses found manual surgery patients used nearly twice as much pain medication (mean [SD] 156.2 [104.1] vs. 86.2 [83.6] MMEs; p < 0.001) and had longer mean (SD) and median LOS (mean 1.5 [0.7] vs. 1.1 [0.5] days and median 1.2 vs. 1.0 days; p < 0.001). After adjustment for age, sex, body mass index, and American Society of Anesthesiology score, manual surgery patients had 1.7 times higher MME consumption (p < 0.05) and 1.4 times longer LOS (p < 0.05). Further adjustment for differences in baseline comorbidities showed more pronounced differences: manual patients had 2.3 times higher MME consumption (p < 0.05) and 1.8 times longer LOS (p < 0.05).
VRAS may facilitate significantly reduced pain medication and shorter LOS with TKA.
本研究比较了VELYS™机器人辅助解决方案（VRAS）与初次全膝关节置换术（TKA）的手动手术在医疗资源利用方面的差异。
回顾了美国一家急救医院一名外科医生实施TKA手术患者的电子病历（手动手术：2019年至2020年；VRAS：2022年至2023年）。主要关注的临床/卫生经济结局是止痛药物使用情况（吗啡毫克当量[MME]）。次要关注的临床/卫生经济结局是住院时间（LOS）。多变量逻辑回归模型考虑了潜在的混杂因素。
在452例TKA病例中（平均[标准差]年龄67.4[9.0]岁，50.2%为男性），215例患者（47.6%）接受了VRAS，237例（52.4%）接受了手动手术。VRAS组患者年龄稍大（67.9岁对66.9岁），男性比例更高（55.7%对46.0%）。未经调整的分析发现，手动手术患者使用的止痛药物几乎是VRAS组的两倍（平均[标准差]156.2[104.1]对86.2[83.6]MME；p<0.001），平均（标准差）和中位住院时间更长（平均1.5[0.7]天对1.1[0.5]天，中位1.2天对1.0天；p<0.001）。在对年龄、性别、体重指数和美国麻醉医师协会评分进行调整后，手动手术患者的MME消耗量高1.7倍（p<0.05），住院时间长1.4倍（p<0.05）。对基线合并症差异进行进一步调整后，差异更为明显：手动手术患者的MME消耗量高2.3倍（p<0.05），住院时间长1.8倍（p<0.05）。
VRAS可能有助于显著减少TKA患者的止痛药物使用量并缩短住院时间。
