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Time-Driven Activity-Based Costs for Manipulation Under Anesthesia after Total Knee Arthroplasty

Gloria Shoshana Coden, MD
UNITED STATES

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Time-Driven Activity-Based Costs for Manipulation Under Anesthesia after Total Knee Arthroplasty

Gloria Shoshana Coden, MD, UNITED STATES Suzanne Kent, MD, UNITED STATES John Mazzocco, MD, UNITED STATES Lauren Schoeller, BS, UNITED STATES Ruijia Niu, MPH, UNITED STATES Daniel C Sun, UNITED STATES Eric L. Smith, MD, UNITED STATES

New England Baptist Hospital, Boston, MA, UNITED STATES

2023 Congress ePoster Presentation 2023 Congress Not yet rated

Anatomic Location

Knee

Diagnosis / Condition

Stiff Joints Osteoarthritis Arthritis

Treatment / Technique

Total Joint Replacement Arthroplasty

Sports Medicine

Economic Analysis

Summary: Most of the cost of manipulation under anesthesia after total knee arthroplasty can be attributed to pre-procedure personnel costs, and length of stay was a risk factor for increased cost.

Introduction

Manipulation under anesthesia (MUA) is an established treatment for postoperative stiffness after total knee arthroplasty (TKA). Since TKA is one of the largest health expenditures in the United States, it is important to understand the financial burden of MUA. Therefore, we sought to assess the costs associated with MUA after TKA.

Methods

We retrospectively reviewed 131 patients who underwent MUA after TKA at a single institution between December 21, 2015 and November 17, 2021. Medical records were reviewed for demographic information. Time-driven activity-based cost analysis was performed to calculate the time and cost associated with each stage of the MUA. Multiple linear regression was performed to determine risk factors for higher total cost. Significance was set at p<0.05.

Results

Mean age was 62.59 years and 65.6 percent (%) of patients were female. Average height was 165.99 centimeters and weight was 86.81 kilograms (kg). Mean body mass index (BMI) was 31.45 kg per meter squared. Mean duration of MUA was 3 minutes 26 seconds. Patients spent on average of 8 minutes 9 seconds before and 7 minutes 20 seconds after the MUA in the procedure room for a total of 18 minutes 55 seconds in the procedure room. All patients were discharged home with a mean length of stay of 4.68 hours. No patients sustained complications related to their MUA.
Average total cost of an MUA was 1172.25 dollars ($), with a mean of $15.87 attributed to supply costs and $1156.39 for personnel costs. Medications accounted for $8.94 of supply costs. All patients had a pre-procedure testing cost of $389.37 and a morning of surgery cost of $333.25, which, on average, accounted for 61.6% of the total cost for the MUA. Mean procedure personnel costs were $239.20 during the procedure, $114.53 in the post-anesthesia care unit (PACU), and $80.03 in phase two. On average, MUAs were found to cost $4.67 per minute throughout length of stay, with a rate of $13.03 per minute in the procedure room, $2.18 per minute in the PACU, and $0.70 per minute in phase two.
Multiple linear regression showed that the increased length of stay (p<0.001) predicted higher total cost for an MUA, but age (p=0.665), gender (p=0.051), height (p=0.644), weight (p=0.486), and BMI (p=0.503) were not associated with increased cost of MUA.

Discussion

61.6% of the cost of an MUA was attributed to personnel costs associated with the pre-procedure process. In addition, length of stay was significantly associated with increased cost of a MUA, and the most expensive part of the MUA occurred when the patient was in the procedure room. To limit the cost of MUAs, we recommend that hospitals attempt to minimize pre-procedure costs and minimize the time that patients are in the hospital, particularly in the procedure room, without sacrificing patient care.

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Central Sensitization is Associated with Persistent Postoperative Pain and Inferior Patient-Reported Outcomes in Patients Undergoing Unicompartmental Knee Arthroplasty ePoster Presentation Yong In, MD, PhD, KOREA, REPUBLIC OF Dongho Kwak, MD, KOREA, REPUBLIC OF Sungcheol Yang, MD, KOREA, REPUBLIC OF Hyukjin Jang, MD, KOREA, REPUBLIC OF Ryu Kyoung Cho, MD, KOREA, REPUBLIC OF Man-Soo Kim, MD, PhD, KOREA, REPUBLIC OF
Palliative Arthroscopic Debridement with Continuous Irrigation for the Infection TKA of High Mortality Risk Patients ePoster Presentation Yoon Sang Jeon, MD, KOREA, REPUBLIC OF Sung-Sahn Lee, MD., PhD., KOREA, REPUBLIC OF Yoon Cheol Nam, MD, KOREA, REPUBLIC OF Dong Jin Ryu, MD, PhD., KOREA, REPUBLIC OF
Use of Tibial Stem for Patients with Morbid Obesity in Total Knee Arthroplasty ePoster Presentation José Eduardo Flores Naranjo, MD, MEXICO Adrian Aziz Cortes De La Fuente, MD, MEXICO Octavio Martinez Montiel, MD, MEXICO Fernando Martinez Zuñiga, MD, MEXICO
Patella in Total Knee Replacement: Patellar Resurfacing has Better Outcomes than Lateral Facetectomy at One Year Follow-Up ePoster Presentation Tomas Alfredo Esteves, MD, ARGENTINA Matias Novillo, MD, ARGENTINA Tomas Nicolino, MD, ARGENTINA Matias Costa-Paz, MD, PhD, ARGENTINA Lisandro Carbó, MD, ARGENTINA Julian Costantini, MD, ARGENTINA
Tibia Placement Difference Between The Supine And Prone Position After Total Knee Arthroplasty: The Comparison Of The BCS and PS-TKA ePoster Presentation Takanori Iriuchishima, MD, PhD, JAPAN Keinosuke Ryu, Prof., JAPAN Eiji Cho, MD, JAPAN
Lateral Unicompartmental Knee Arthroplasty (UKA) Showed a Lower Risk of Failure Compared to Medial Unicompartmental Knee Arthroplasty in the Register of Prosthetic Orthopedic Implants (RIPO) ePoster Presentation Stefano Zaffagnini, MD, Prof., ITALY Domenico Alesi, MD, ITALY Barbara Bordini, Stat, ITALY Stefano Fratini, MD, ITALY Cristina Ancarani, Stat, ITALY Piero Agostinone, MD, ITALY Alberto Grassi, PhD, ITALY Giulio Maria Marcheggiani Muccioli, MD, PhD, Associate Professor, ITALY
Is Surgeon Assessed Bone Quality During Total Knee Arthroplasty a Valid Tool To Diagnose Osteoporosis ? ePoster Presentation Adit Rajesh Maniar, MBBS, MS Orthopaedics, DNB Orthopaedics, INDIA Arpit Vasantbhai Bavaskar, MBBS, D.Orth., INDIA Vishal Raina, MS, INDIA Akshay Nayak, M.B.B.S, M.S , INDIA Ashwini Khokhar, MS, INDIA Rajesh Maniar, INDIA
Bilateral Simultaneous Unicompartimental Knee Arthroplasty. Midterm Results in 86 Arthroplasties with an Average Follow-Up Of 6.2 Years ePoster Presentation Stefano Gaggiotti, MD, ARGENTINA Gabriel Gaggiotti, MD, ARGENTINA Santino Gaggiotti, MD, ARGENTINA Julio Cesar Ringa
Does 1000 Mg Ferric Carboxylate Maltose Have an Additional Benefit on the Haemoglobin Recovery Post Total Knee Arthroplasty? - A Comparison with 500 Mg of Ferric Carboxymaltose ePoster Presentation Adit Rajesh Maniar, MBBS, MS Orthopaedics, DNB Orthopaedics, INDIA Ashwini Khokhar, MS, INDIA Akshay Nayak, M.B.B.S, M.S , INDIA Naveen Chandar, MBBS, INDIA Abhinav Mishra, MS, DNB, INDIA Rajesh Maniar, INDIA
Antero-Posterior Translation of Mobile-Bearing in Mobile-Bearing Unicompartmental Knee Arthroplasty ePoster Presentation Takahiro Arakawa, MD, JAPAN Kenichi Kono, MD, PhD, JAPAN Tetsuya TOMITA, MD, PhD, JAPAN Shuji Taketomi, MD, PhD, JAPAN Ryota Yamagami, MD, JAPAN Kohei Kawaguchi, MD, PhD, JAPAN Tomofumi Kage, JAPAN Ryo Murakami, MD, JAPAN Hiroshi Inui, PhD, JAPAN Sakae Tanaka, MD, PhD, JAPAN
How to Measure Physical Function in Clinical Trials on Patients Undergoing Total or Partial Knee Arthroplasty? A Systematic Review ePoster Presentation Marco Adriani, MD, ITALY Roland Becker, MD, PhD, Prof., GERMANY Aleksandra Krolikowska, PhD, Prof., POLAND Krzysztof Lachowski, MD, GERMANY Robert Prill, PhD, GERMANY
Short-Term Clinical Outcome Of Functionally Aligned Robotic-Assisted BCS TKA is Better Than That Of Mechanically Aligned Navigation-Assisted BCS TKA ePoster Presentation Daisuke Hamada, MD, PhD, JAPAN Keizo Wada, MD, JAPAN Yasuaki Tamaki, MD, JAPAN Yasuyuki Omichi, MD, JAPAN Tomohiro Goto, MD, PhD, JAPAN Koichi Sairyo, MD, PhD, JAPAN

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Time-Driven Activity-Based Costs for Manipulation Under Anesthesia after Total Knee Arthroplasty

Time-Driven Activity-Based Costs for Manipulation Under Anesthesia after Total Knee Arthroplasty

Introduction

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Discussion

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Time-Driven Activity-Based Costs for Manipulation Under Anesthesia after Total Knee Arthroplasty

Time-Driven Activity-Based Costs for Manipulation Under Anesthesia after Total Knee Arthroplasty

Introduction

Methods

Results

Discussion

More 2023 ISAKOS Congress Content