LAS VEGAS — Robotic-assisted total knee arthroplasty (TKA) procedures cost about 26% more than traditional procedures, according to a retrospective cohort study presented here, but patients spent fewer days in the hospital and suffered fewer complications.
Among more than 5,000 patients undergoing TKA procedures, the median cost was higher in the robotic-surgery group ($12,805) versus traditional treatment ($10,162), and operative time was longer (101 vs 94 minutes), reported Chris Neighorn, of Providence Health Services in Portland, Oregon, and colleagues.
But the complication rate was markedly lower (0.7% vs 2.4%), as was the median length of stay (1.2 vs 2.2 days, P<0.0001 for all comparisons), according to the presentation at the 2019 annual meeting of the American Academy of Orthopaedic Surgeons.
The findings provide more evidence that robotic orthopedic surgery isn’t harmful to patients, said orthopedic surgeon Assem A. Sultan, MD, of Cleveland Clinic, who reviewed the findings for MedPage Today.
The new study joins others that show “either equal or superior functional and radiographic outcomes,” Sultan said.
For the new study, researchers retrospectively reviewed 1,285 robotic TKA and 3,930 traditional TKA procedures at nine West Coast hospitals. All were performed by 16 surgeons with the Stryker MAKO robot over the past 2 years, and each surgeon was a veteran of at least 15 TKA surgeries.
There were slight differences between the two groups: Patients in the robotic TKA group were slightly younger and slightly less obese on average, and they had a lower baseline functional score. At follow-up, there was no difference in functional scores between the two groups.
The researchers did not adjust for confounders. “The largest would have been demographic differences and differences in follow-up. Hopefully, these could be sorted out in a follow-up, prospective study,” said Kevin Fleming, MBA, a senior executive at Providence Health who oversaw the research.
Cleveland Clinic’s Sultan, who was not involved in the current study, co-authored a 2018 review of studies on robotic TKA. The review reported that advantages of the technology “may include greater component accuracy and precision, soft-tissue protection, increased patient satisfaction, a short learning curve, optimal ergonomic design, and less surgeon and surgical team fatigue.” Sultan’s group also found that most studies so far have focused on short-term outcomes.
According to Fleming, the study findings suggest that hospitals should carefully study the financial impact of robotic surgery, which appears to come with a “significant learning curve” and higher costs.
“The capital acquisition costs and annual operating costs for the robots are significant when compared to non-robotic procedures,” he said. “There are also disposable items used for each procedure. These costs, coupled with a learning curve to become efficient with the robot, impact the direct cost per procedure and the time needed to perform it.”
Moving forward, more research into robotic orthopedic surgery is needed to fully understand the value of the technology, Sultan said, especially in light of the fact surgeons are trying it out in less complicated cases. “Most studies have focused on complications and readmissions,” he said, “and there is limited literature on functional outcomes. We also need more studies focused on cost analysis, telling us what the cost implication is.”
No funding for the study is reported. Neither Fleming nor Sultan report relevant disclosures.