Lengths of Stay and Discharge Dispositions after Total Knee Arthroplasty: A Comparison of Robotic-Assisted and Manual Techniques

Abstract

As evidence signifies that short-stay total knee arthroplasties (TKA) can be safe options, it is important to identify factors that contribute to early discharge. There is evidence that robotic-assisted TKAs may lead to shorter lengths of postoperative stays. However, this has not been evaluated as the primary outcome of interest in a large-scale population. The purpose of this study was to compare manual and robotic-assisted TKAs with regard to: (1) length of stay (LOS) and (2) discharge dispositions. TKAs performed between January 1, 2018, to March 31, 2019, were identified. After applying inclusion and exclusion criteria, a total of 10,296 patients were included: 5,993 in the manual and 4,303 in the robotic-assisted group. Length of stay, discharge dispositions, and Charlson comorbidity indices (CCIs) were recorded for all patients. The mean LOS was significantly lower in robotic-assisted (1.68 ± 0.86 days) compared with manual (1.86 ± 0.94 days) TKA procedures (p < 0.00001). In the robotic-assisted group, 2,049 (47.6%) were discharged in 1 day or less compared with 2,325 (38.8%) in the manual group (p < 0.0001). The proportion discharged home was significantly higher for patients who underwent robotic-assisted (91.3%) compared with manual (87.4%) TKAs (p < 0.00001). When comparing only patients who were discharged home and who did not have home health services, the rate was 51.8% in the robotic-assisted group compared with 44.0% in the manual group (p < 0.00001). The mean CCI was similar for patients who underwent robotic-assisted (2.9 ± 1.4 points) compared with manual (3.0 ± 1.5 points) TKAs. There was a trend toward shorter mean LOS for robotic-assisted versus manual TKA at 17 of the 24 included hospital sites (70.8%). Compared with manual, robotic-assisted TKAs demonstrated shorter lengths of postoperative stays and less need for skilled care after discharge. These results suggest the health care burden resulting from an upsurge of TKA procedures in our aging population might be addressed in part by increased utilization of robotic assistance.

Inflammatory Response in Robotic-Arm-Assisted Versus Conventional Jig-Based TKA and the Correlation with Early Functional Outcomes

“…Finally, pain scores were significantly lower in the robotic group, and this was found to be correlated predominantly with systemic inflammation. The lower pain levels suggest that robotic TKA could result in faster recovery and a shorter length of stay, as has been reported in larger studies 38-40 . However, we were not able to demonstrate that directly in our relatively small sample.…”

Length of stay and discharge dispositions following robotic arm-assisted total knee arthroplasty and unicompartmental knee arthroplasty versus conventional technique and predictors of delayed discharge

“…Our findings are rather discordant with previously published studies conducted in the USA, that insinuate benefits of robotic arm assistance. Archer et al 4 reported a significantly higher proportion of patients undergoing RO TKA were discharged home (91.3% vs 87.4%, p < 0.001). Similarly, Hamilton et al 26 showed that more patients in the RO TKA group were discharged home (90.4% vs 79.5%) instead of a subacute rehabilitation facility (9.6% vs 20.5%; 0.051, Pearson chi-squared test and 0.041, Fisher’s exact test).…”

“…Our results are in concordance with previous studies. Archer et al 4 retrospectively looked at 10,296 patients undergoing robotic arm-assisted (n = 4,303) or conventional (n = 5,993) TKA, and reported a significantly lower mean LOS in the robotic group (1.68 days, standard deviation (SD) 0.86) compared with the conventional (1.86 days, SD 0.94, p < 0.001). Grosso et al 20 also conducted a large-scale study among 4,086 primary TKAs and reported shorter LOS when robotic arm assistance was used (1.46 vs 1.80 days, p < 0.001).…”

“…To our knowledge, this is only the second large-scale study to explore the impact of robotic technology on LOS and discharge destinations as primary outcomes of interest in TKA, and the first one to look at UKA. 4 Additionally, our study encompasses regression analyses to identify predictors of delayed discharge, and is the first large-scale study presenting data from a publicly funded healthcare system. Furthermore, we aimed to capture variables that could potentially confound our results, including age, sex, BMI, index of deprivation, type of anaesthesia, and medical comorbidities represented by the ASA grade.…”

“…1 There is mounting evidence to suggest that reducing LOS can combat the cost increase, and it is safe when applied to selected populations, using well-defined discharge criteria. [2][3][4] Decreased mobility in the immediate postoperative period and pain are wellrecognized factors that impede functional recovery, thereby increasing LOS.…”