PMD21 ROBOTIC-ASSISTED TOTAL HIP REPLACEMENT: A 90-DAY EPISODE OF CARE ANALYSIS

Abstract

Robotic-assisted Total Hip Arthroplasty (RATHA), studies have shown increased accuracy in placing implants and improvements in; patient outcomes, satisfaction scores and post-op complications compared to manual THA (mTHA). The purpose of this study was to compare robotic-assisted vs. manual total hip arthroplasty index and post-discharge utilization and costs in a 90-day episode-of-care (EOC). THA procedures were identified using the Medicare 100% Standard Analytic Files. Members included patients with RATHA or mTHA between 10/1/2015-10/1/2018. Propensity score matching (PSM) was performed in a 1-to-5 ratio, robotic to manual. After PSM, 938 rTHA and 4,670 mTHA were identified and included for analysis. Ninety-day episode-of-care cost, index cost, LOS, post-index rehab utilization and costs were assessed. RATHA patients were less likely to have post-index IPR or SNF admissions (0.64% vs. 2.68%; p<0.0001 and 20.79% vs. 24.99%; p=0.0041, respectively). RATHA patients used fewer days in post-index inpatient and SNF care (7.15 vs. 7.91; p=0.8029 and 17.98 vs. 19.64; p=0.5080, respectively) and used fewer HHA visits, (14.06 vs. 15.00; p=0.0006) compared to mTHA. RATHA had lower costs for; IPR ($11,490 vs. $14,674; p=0.0470), SNF ($9,184 vs. $10,408, p=0.0598) and HHA ($3,352 vs. $3,496; p=0.0133) compared to mTHA. Overall, RATHA patients had 12% ($948) lower average post-index costs compared to mTHA patients (p=0.0004). Total 90-day EOC costs for RATHA patients were found to be $785, less than that of mTHA patients ($19,734 vs. $20,519, p=0.0095). Robotic-assisted THA resulted in an overall lower 90-day episode-of-care cost when compared to manual THA. The 90-day EOC cost savings of RATHA were driven by reduced utilization and cost of post-index rehabilitation services including, IPR, SNF and HHA.