A Time-Driven Activity-Based Costing Analysis of Simultaneous Versus Staged Bilateral Total Hip Arthroplasty and Total Knee Arthroplasty

Goh, Graham S.; Sutton, Ryan; D’Amore, Taylor; Baker, Colin M.; Clark, Sean; Courtney, P. Maxwell

doi:10.1016/j.arth.2022.01.048

Cited by 12 publications

(7 citation statements)

References 36 publications

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“…Based on 12 studies [ 18 – 20 , 24 , 25 , 29 , 34 , 37 , 38 , 41 , 42 , 54 ], the mean operation time was 171.4 min for simBTHA and 191.4 min for stgBTHA. Cumulative operation time for both surgeries in stgBTHA was longer than simBTHA operation time in all studies except the study by Kim et al [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

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Simultaneous versus staged bilateral total hip arthroplasty: a systematic review and meta-analysis

et al. 2022

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Background Total hip arthroplasty is a common orthopedic surgery for treating primary or secondary hip osteoarthritis. Bilateral total hip replacement could be performed in a single stage or two separate stages. Each surgical procedure's reliability, safety, and complications have been reported controversially. This study aimed to review the current evidence regarding the outcomes of simultaneous and staged bilateral total hip arthroplasty. Methods We conducted a meta-analysis using MEDLINE, EMBASE, Web of Science, and Scopus databases. Eligible studies compared complications and related outcomes between simultaneous and staged bilateral THA. Two reviewers independently screened initial search results, assessed methodological quality, and extracted data. We used the Mantel–Haenszel method to perform the meta-analysis. Results In our study, we included 29,551 patients undergoing simBTHA and 74,600 patients undergoing stgBTHA. In favor of the simBTHA, a significant reduction in deep vein thrombosis (DVT) and systemic, local, and pulmonary complications was documented. However, we evidenced an increased pulmonary embolism (PE) and periprosthetic fracture risk in simBTHA. In the simBTHA, total blood loss, length of hospital stay, and total cost were lower. Conclusion This meta-analysis shows that simultaneous bilateral THA accompanies fewer complications and lower total cost. Well-designed randomized controlled trials are needed to provide robust evidence.

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Section: Resultsmentioning

confidence: 99%

“…Functional recovery was faster in simBTHA, as walking without support started earlier [ 36 ] and walking capacity was better postoperatively [ 21 , 28 ]. Rates of home-discharged patients for stgBTHA were higher in all studies [ 25 , 26 , 40 , 41 , 43 , 49 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

Simultaneous versus staged bilateral total hip arthroplasty: a systematic review and meta-analysis

et al. 2022

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“…On the other hand, another systematic review that included only studies from the last decade and had comparable preoperative characteristics, reported no difference in mortality, overall complications, thromboembolic events, cardiac complications, and revision rates between simBTKA and staBTKA 12 . In addition, two recent studies reported that complication rates were not affected by the choice for simultaneous or staged arthroplasty 4,5 . The lack of randomized controlled trials causes this debate to continue.…”

Section: Introductionmentioning

confidence: 99%

“…for the healthcare system, patient convenience and satisfaction, single anesthesia and hospitalization, less total anesthesia time, faster postoperative recovery, and symmetrical postoperative rehabilitation among both knees 4,5 . In addition, simultaneous procedures provide an average of six months to patients' quality-adjusted life years 6 .…”

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confidence: 99%

Comparison of safety and efficiency between sequential simultaneous bilateral and staged bilateral total knee arthroplasty at a high-volume center: a retrospective cohort study

ÇELEN,

ÖZKURT,

AYDIN

et al. 2023

Acta Orthop Belg

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The treatment strategy remains controversial for bilateral end-stage osteoarthritis, particularly with regard to patient safety. The aim of this study was to compare the safety and clinical results of sequential simultaneous bilateral total knee arthroplasty (ssBTKA) and staged bilateral total knee arthroplasty (staBTKA). Patients who underwent either simultaneous (n=168) or staged (n=63) bilateral total knee arthroplasty in a single center between February 2017 and April 2021 were identified retrospectively. Data related to age, gender, body mass index, ASA score, comorbidities, operative time, transfusion rate, length of stay, knee range of motion (ROM), Knee Society Score (KSS), complications, and mortality rates were evaluated. Mean follow-up duration was 39.0±14.7 months. Preoperative characteristics were similar among cohorts. Transfused units were significantly higher in the ssBTKA group (p<0.001). Operative time and length of stay were significantly higher in the staBTKA group (respectively, p<0.001 and p=0.004). Complication rates (except superficial infection rate which was significantly higher in the staBTKA group), revision rates, mortality rates and functional outcomes were statistically similar between the groups (p>0.05). Presence of preoperative coronary artery disease comorbidity was significantly associated with increased postoperative myocardial infarction risk (p=0.001). ssBTKA provided similar functional results, shorter cumulative hospital stay and shorter operative time without increasing complications and mortality rates compared to staBTKA procedure. For patients with pre-existing coronary artery disease, a more cautious approach should be preferred to decrease complications.

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“…11,12 Notably, data from various studies have determined that mean costs for SimBTKA were lower than those for StaBTKA across different countries. 11,13,14 Therefore, we hypothesized that the implementation of SimBTKA would not compromise clinical outcomes and may, in fact, offer distinct advantages in terms of cost-effectiveness when compared to StaBTKA.…”

mentioning

confidence: 99%

Comparison of the cost-effectiveness and safety between staged bilateral total knee arthroplasty and simultaneous bilateral total knee arthroplasty: a retrospective cohort study between 2001 and 2022

Tsui,

Chan,

Cheung

et al. 2024

J Knee Surg

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Introduction: A substantial proportion of Hong Kong’s aging population suffers from osteoarthritis in both knees. Bilateral total knee arthroplasty (BTKA) is a surgical option for addressing this condition and can be performed via two approaches: simultaneous (SimBTKA) and staged (StaBTKA) bilateral TKAs. We compared the cost-effectiveness and safety of these two methods in our institution. Methods: We retrospectively reviewed 2,372 patients (SimBTKA, 772; StaBTKA, 1,600; female, 1,780; male, 592; mean age at SimBTKA, 70.4 ± 7.99 years; mean age at StaBTKA, 66.4 ± 7.50 years; p < 0.001) who underwent bilateral TKA in our institution from 2001 to 2022. Patients were categorized according to surgical approach. Patients undergoing BTKA in our institution were included. Particularly for SimBTKA, patients were assessed by anesthetists to be medically fit before undergoing SimBTKA according to their age, American Society of Anesthesiologists status, and osteoarthritis severity. Primary outcome was the length-of-stay (LOS) after surgery. Secondary outcomes were the 30-day unintended readmission, intensive care unit (ICU) admission, and death. Results: SimBTKA had a short mean total LOS (acute hospital + rehabilitation center; SimBTKA, 13.09 days; StaBTKA, 18.12 days; p < 0.001) and mean LOS in acute hospital (SimBTKA, 7.70 days; StaBTKA, 10.42 days; p < 0.001). However, no significant difference was found in mean LOS in rehabilitation centers (SimBTKA, 5.47 days; StaBTKA, 6.32 days; p > 0.05) between the two approaches. The 30-day unintended readmission rate was low in SimBTKA (SimBTKA, 2.07%; StaBTKA, 3.30%; OR = 1.60; p > 0.05) but statistically insignificant. SimBTKA was less costly than StaBTKA by US$8,422.22. per patient. No significant differences in ICU admission and death rates were found (p > 0.05) between the two groups. Conclusion: SimBTKA had a shorter LOS and lower cost than StaBTKA and comparable complication rates. Therefore, SimBTKA should be indicated in medically stable patients. Keywords: Total knee arthroplasty, Cost-Effectiveness, Aging, Pain, Anesthesia

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A Time-Driven Activity-Based Costing Analysis of Simultaneous Versus Staged Bilateral Total Hip Arthroplasty and Total Knee Arthroplasty

Cited by 12 publications

References 36 publications

Simultaneous versus staged bilateral total hip arthroplasty: a systematic review and meta-analysis

Simultaneous versus staged bilateral total hip arthroplasty: a systematic review and meta-analysis

Comparison of safety and efficiency between sequential simultaneous bilateral and staged bilateral total knee arthroplasty at a high-volume center: a retrospective cohort study

Comparison of the cost-effectiveness and safety between staged bilateral total knee arthroplasty and simultaneous bilateral total knee arthroplasty: a retrospective cohort study between 2001 and 2022

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