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

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Citation: Journal of the American Academy of Orthopaedic Surgeons. 29(14):609-615, 2021 Jul 15.PMID: 32991384Institution: MedStar Union Memorial HospitalDepartment: Orthopaedic SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Arthroplasty, Replacement, Hip | *Robotics | Arthroplasty, Replacement, Hip/ae [Adverse Effects] | Hospital Charges | Hospitals | Humans | Length of Stay | Postoperative Complications/ep [Epidemiology] | Retrospective Studies | Risk Factors | Treatment OutcomeYear: 2021ISSN:
  • 1067-151X
Name of journal: The Journal of the American Academy of Orthopaedic SurgeonsAbstract: 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.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).LEVEL OF EVIDENCE: Level III, retrospective cohort analysis.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 All authors: Haislup B, Kerbel YE, Kirchner GJ, Lieber AM, Moretti VMOriginally published: Journal of the American Academy of Orthopaedic Surgeons. 2020 Sep 25Fiscal year: FY2022Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2020-12-29
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Journal Article MedStar Authors Catalog Article 32991384 Available 32991384

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.

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).

LEVEL OF EVIDENCE: Level III, retrospective cohort analysis.

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 0,046 (SD = 6,165) compared with 8,258 (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).

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