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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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The Effect of Minor Adjustments to Tibial and Femoral Component Position on Soft Tissue Balance in Robotic Total Knee Arthroplasty ePoster Presentation Simon W. Young, MD, FRACS, NEW ZEALAND Matthew Carter, NEW ZEALAND Gavin William Clark, MBBS, FRACS, AUSTRALIA Christina Esposito, PhD, AUSTRALIA Matthew Walker, MBChB, FRACS, NEW ZEALAND
Intra- And Inter-Operator Reliability Assessment Of A Novel Extramedullary Accelerometer-Based Smart Cutting-Guide For Total Knee Arthroplasty: An In-Vivo Study ePoster Presentation Stefano Zaffagnini, MD, Prof., ITALY Domenico Alesi, MD, ITALY Arcangelo Russo, MD, ITALY Mirco Lo Presti, MD, ITALY Iacopo Sassoli, MD, ITALY Matteo La Verde, MD, ITALY Giulio Maria Marcheggiani Muccioli, MD, PhD, Associate Professor, ITALY
Association Between The Femoral And Tibial Component Positions and Intraoperative Knee Kinematics In Posterior-Stabilized Total Knee Arthroplasty ePoster Presentation Mitsuru Hanada, MD, PhD, JAPAN Yukihiro Matsuyama, MD, PhD, Prof., JAPAN
Incidence and Prevention of Deep Vein Thrombosis Using Thromboprophylaxis in Total Knee Replacement: A Prospective Clinical Study ePoster Presentation Amit Lakhani, MS, DNB, MRCPS(Glassg), MNAS, INDIA
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
Impact of Femur Correction on the Mechanical Alignment of the Total Knee Prosthesis ePoster Presentation Israel Alejandro Alejandro González Rizo, MD, MEXICO Fidel G Dobarganes, Prof, MEXICO Jorge Negrete Corona, MD, MEXICO Alberto Guevara-Alvarez, MD, MEXICO Franco Garcini Munguia, MD, MEXICO
High Cure Rate In Hematogenous TKA PJI At A Long-Term Follow-Up By Means Of Dair Procedure ePoster Presentation Daniel Pérez-Prieto, MD, SPAIN Albert Fontanellas, MD, SPAIN Raúl Torres-Claramunt, PhD, SPAIN Juan Francisco Sanchez-Soler, MD, PhD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN Pedro Hinarejos, MD, PhD, SPAIN
Combined Single-Shot Infiltration Between the Popliteal Artery and Capsule of the Knee and Adductor Canal Block with Bupivacaine, Dexmedetomidine, and Dexamethasone for Total Knee Arthroplasty: A Propensity-Matched Analysis ePoster Presentation David Freccero, MD, UNITED STATES Aneesh V Samineni, BA, UNITED STATES Seroos Salavati, MD, UNITED STATES
In-Vivo Kinematic Analysis of Evolution® Medial-Pivot Total Knee Arthroplasty during Weight-Bearing Activity ePoster Presentation Eiichi Nakamura, MD, PhD, JAPAN Nobukazu Okamoto, MD, PhD, JAPAN Hitoshi Ito, MD, PhD, JAPAN Tetsurou Masuda, MD, PhD, JAPAN Satoshi Hisanaga, MD, PhD, JAPAN Yasunari Oniki, MD, PhD, JAPAN
Accuracy of Advanced Active Robotic Technology for Total Knee Arthroplasty: A Cadaveric Study ePoster Presentation Yong-Beom Park, MD, PhD, KOREA, REPUBLIC OF Seong-Hwan Kim, MD,Ph.D, MStat, KOREA, REPUBLIC OF Young-Bong Ko, MD, KOREA, REPUBLIC OF
Golfers Have Greater Preoperative and Equal Postoperative Function When Undergoing Total Knee Arthroplasty Compared to Non-Golfers ePoster Presentation Patrick G Robinson, MBChB, MRCS, MS, MBA, UNITED KINGDOM Robert Kay, MBChB, UNITED KINGDOM Deborah Macdonald, BA(Hons), UNITED KINGDOM Andrew Murray, MBChB, FFSEM, UNITED KINGDOM Nick David Clement, MBBS, MD, PhD, FRCS(Orth), UNITED KINGDOM
Differences In Pain, Sleep Status And Functional Recovery Between TKA And UKA ePoster Presentation Takeo Mammoto, MD, JAPAN
Preoperative Bone Marrow Edema Negatively Impacts Intermediate to Long-Term Outcomes after Unicompartmental Knee Arthroplasty ePoster Presentation Hong Yeol Yang, MD, PhD, KOREA, REPUBLIC OF Jong-Keun Seon, MD, PhD, Prof, KOREA, REPUBLIC OF
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

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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