The Cost of Robot-assisted Total Hip Arthroplasty: Comparing Safety and Hospital Charges to Conventional Total Hip Arthroplasty

Abstract

Introduction: Utilization of robotic assistance is increasing for total hip arthroplasty (THA). However, few studies have directly examined the efficacy of this technique at reducing complications. This research aims to compare the rates of perioperative complications of robotic-assisted THA (RA-THA) with conventional THA (C-THA). Methods: This study screened more than 35 million hospital discharges between 2010 to 2014 using the National Inpatient Sample. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes were used to identify 292,836 patients who underwent C-THA (ICD 81.51) and 946 patients who underwent RA-THA (ICD 81.51 and ICD 17.41, 17.49). Perioperative complications were identified using ICD-9-CM diagnosis codes. Patient mortality was determined using the Uniform Bill patient disposition. The RA-THA cohort was statistically matched 1:1 to C-THA about patient age, sex, race, comorbidities, hospital type, and calendar year. Mean cost and length of stay (LOS) for each cohort were calculated and compared using the Kruskal-Wallis H test. Logistic regression was used to compare the risks of major and minor complications between the cohorts. Results: We matched 758 (80.13%) RA-THA patients with 758 patients who underwent C-THA. No patient in our sample died. When compared with the conventional group, multivariate analysis revealed that the risk of major complications was similar in RA-THA patients (odds ratio = 0.698, 95% confidence interval = 0.282 to 1.727). In addition, although the rate of minor complications was higher in the RA-THA cohort (21.6% versus 12.5%, P = 0.004), no difference was observed on multivariate analysis (odds ratio = 1.248, 95% confidence interval = 0.852 to 1.829). The average inpatient hospital cost of a RA-THA was $20,046 (SD = 6,165) compared with $18,258 (SD = 6,147) for C-THA (P < 0.001). The average LOS was for RA-THA was 2.69 days (SD = 1.25) compared with 2.82 days for C-THA (SD = 1.18, P < 0.001). Discussion: In a statistically matched cohort, the risk of perioperative complication in patients who underwent RA-THA versus C-THA patients were similar. However, RA-THA was costlier despite shorter LOS. Level of Evidence: Level III, retrospective cohort analysis

Robotic‐arm assisted versus manual total hip arthroplasty: Systematic review and meta‐analysis of radiographic accuracy

“…For example, Kirchner et al. recently evaluated inpatient costs between RA‐THA and matched mTHA patients and found significantly higher average costs among the RA‐THA cohort ($20,046 vs. $18,258; p < 0.001) despite significantly lower length of stay (2.69 vs. 2.82; p < 0.001) 52 . Conversely, a Markov model analysis by Maldonado et al.…”

“…recently demonstrated that RA‐THA was associated with a cost saving with an average differential of $1810 among private insurers and $945 for Medicare compared to manual THA 53 . As their analysis failed to consider the significant capital needed to purchase robotic systems, 52,54 centres with limited financial resources and case volume may not be able to implement related technologies.…”

Comparison of Utilization and Short-term Complications Between Technology-assisted and Conventional Total Hip Arthroplasty

“…In the existing literature, the association between TA-THA and shorter LOS is unclear. Although several studies support this finding, 6,8,28,33 an NIS database analysis consisting of patients undergoing THA from 2005 to 2014 found no association. 16 In our analysis, patients in the TA-THA cohort were more likely to be discharged home as compared with the U-THA cohort, which is consistent with the prior literature.…”

Bilgisayar navigasyonlu ve robotik kol yardımlı total diz protezi uygulamaları

“…Robotik kol yardımlı artroplastinin sorunlarından biri de konvansiyonel protez cerrahisine göre daha pahalı olmasıdır. Bu konuda yapılmış çalışmalar da [22] bunu göstermiş olup fiyat-etkinlik oranı açısından literatürde yapılmış kanıt düzeyi yüksek çalışma bulunmamaktadır. Ayrıca robotik cerrahide kemiklere 'array' adı verilen sensörler yerleştirilmekte olup ekstra kemik girişinin olması kırık ya da enfeksiyon açısından riskli olabileceği konusunda tartışmaya neden olmaktadır.…”