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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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Three-Dimensional Evaluation of Distal Femoral Valgus Angle Using Whole Leg CT in Total Knee Arthroplasty ePoster Presentation Atsushi Sato, MD, PhD, JAPAN Jun Oike, MD, PhD, JAPAN Masataka Ota, MD, JAPAN Kanako Izukashi, MD, JAPAN Saki Yagura, MD, JAPAN Takayuki Okumo, MD, PhD, JAPAN Naoki Okuma, MD, JAPAN Takayuki Koya, MD, PhD, JAPAN Fumiyoshi Kawashima, MD, JAPAN Hiroshi Takagi, MD, PhD, JAPAN Koji Kanzaki, Prof., JAPAN
Long-Term Results of Per-Operative Knee Arthroscopy in Confirming Suitability for Unicompartmental Arthroplasty ePoster Presentation James Gill, MB BChir, BSc, FRCS, UNITED KINGDOM McMeniman J Peter, AUSTRALIA Timothy John Mcmeniman, MBBS(Med)/MBBS, FRACS FA(Orth)A, AUSTRALIA Daniel Johnson Brimm, BSc, MD, AUSTRALIA Peter T. Myers, AM, MBBS, FRACS, FAOrthA, AUSTRALIA
Detection Loosening of Total Knee Arthroplasty Implant from Plain Radiograph Using Machine Learning Algorithm ePoster Presentation Man-Soo Kim, 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 Yong In, MD, PhD, KOREA, REPUBLIC OF
The Functional Outcome of Zimmer Biomet’s Nexgen Total Knee Arthroplasty as Compared with Healthy Older Adults ePoster Presentation Gwenllian F. Tawy, PhD, MRes, BSc(Hons), UNITED KINGDOM Michael J. McNicholas, BSc, MD, FRCS Tr & Orth, UNITED KINGDOM Leela C. Biant, MS, MFSTEd, FRCSEd(Tr&Orth), UNITED KINGDOM
Relationship Between The Femoral And Tibial Component Positions And Postoperative Knee Range Of Motion After Posterior-Stabilized Total Knee Arthroplasty ePoster Presentation Mitsuru Hanada, MD, PhD, JAPAN Yukihiro Matsuyama, MD, PhD, Prof., JAPAN
Factors Associated With Failure and Survivorship Following Unicompartmental Knee Arthroplasty: A Single-Center Experience ePoster Presentation Anirudh K Gowd, MD, UNITED STATES Johannes F. Plate, MD, PhD, UNITED STATES Asher Lichtig, MD, UNITED STATES Orhan Yanmis, MD, UNITED STATES Gary G. Poehling, MD, UNITED STATES
Treatment of Periprosthetic Infection after Total Knee Arthroplasty using an Ultrastatic Spacer ePoster Presentation Gloria Shoshana Coden, MD, UNITED STATES Suzanne Kent, MD, UNITED STATES Ruijia Niu, MPH, UNITED STATES Ayesha Abdeen, MD, UNITED STATES Eric L. Smith, MD, UNITED STATES
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
Participation of Physical Activity Following Knee Arthroplasty: A Meta-Analysis ePoster Presentation Ahmed A Magan, BM BSc (Hons) MRCS (Eng) FRCS (Eng) Trauma & Orth, UNITED KINGDOM Babar Kayani, BSc (HONS), MBBS, MRCS (Eng), UNITED KINGDOM Warran Wignadasan, MBBS, BSc (Hons), MRCS, UNITED KINGDOM Dia Eldean Giebaly, MBChB, MSc, FRCS, EMBA, UNITED KINGDOM Flaminia Ronca, PHD, UNITED KINGDOM Fares S. Haddad, MCh(Orth), BSc, FRCS(Orth), UNITED KINGDOM
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
Same Complication Rate After Day-Case Procedure Or Fast-Track Procedure After Total Hip And Knee Arthroplasty. A Prospective, Propensity Score-Matched Case-Control Study ePoster Presentation Jean-Yves Jenny, Prof., FRANCE Vincent Gisonni, MD, FRANCE
Short Term Outcome of Tibial Defect Reconstruction In Primary Total Knee Arthroplasty: A Retrospective Study ePoster Presentation Sanjib Kumar Behera, MS (Orth), DNB (Rehab), DPMR, INDIA Madhumita Pradhan, BDS, MPH, MHA , INDIA Vikram Choudhary, MD, UNITED STATES
Quality of Life Following Primary Total Knee Arthroplasty: Factors Predicting Satisfaction in Low-Income Population ePoster Presentation Mohamed Amine Gharbi , MD, TUNISIA Houssem Eddine Chahed, MD, TUNISIA Ahmed Zendeoui, MD, TUNISIA Moatassem Belleh Jelassi, MD, TUNISIA Anis Tebourbi, MD, TUNISIA Ramzi Bouzidi, PhD, TUNISIA Khelil Ezzaouia, PhD, TUNISIA Mouadh Nefiss, MD, TUNISIA
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

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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