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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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Calipered Measurements Method For Kinematically Aligned Total Knee Arthroplasty Has A Risk Of Excessive Varus Cut For The Proximal Tibia In Japanese Varus Knees ePoster Presentation Umito Kuwashima, MD, PhD, JAPAN Masafumi Itoh, MD, PhD, JAPAN Junya Itou, MD, JAPAN Ken Okazaki, MD, PhD, JAPAN
Phenotypic Differences In Coronal Alignment In Robot-Assisted Total Knee Arthroplasty Do Not Affect Patient-Reported Outcome Measurements In A Three-Dimensional Computed Tomography Analysis: A Single-Center Cohort Study ePoster Presentation Takao Kaneko, MD, PhD,, JAPAN Ayakane Yamamoto, MD, JAPAN Kazutaka Takada, MD, JAPAN Shu Yoshizawa, MD, JAPAN Hiroyasu Ikegami, MD, PhD, Prof., JAPAN
Tibial Morphology for Proper Adjustment of Metal Augmentation in Revision Total Knee Arthroplasty ePoster Presentation Yushi Sakamoto, MD, JAPAN Shinichiro Nakamura, MD, PhD, JAPAN Yugo Morita, MD, JAPAN Shinichi Kuriyama, MD, PhD, JAPAN Kohei Nishitani, MD, PhD, JAPAN Young Dong Song, MD, PhD, UNITED STATES Yusuke Yamawaki, MD, JAPAN Shuichi Matsuda, MD, PhD, JAPAN
Effect of Direct Adductor Canal Block Performed by a Surgeon in a Patient Who Underwent Simultaneous Bilateral TKA 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
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, MD, PhD, JAPAN Eiji Cho, MD, JAPAN
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
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
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
Bicruciate Substituting Total Knee Arthroplasty Improved Anteroposterior Displacement in Mid-Flexion Range ePoster Presentation Keinosuke Ryu, MD, PhD, JAPAN Takanori Iriuchisima, MD, JAPAN
Impact of Femur Correction on the Mechanical Alignment of the Total Knee Prosthesis ePoster Presentation Israel 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
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
Success of Debridement, Antibiotics, and Implant Retention vs Revision In Early And Late Prosthetic Joint Infections Following Primary TKA: A Prospective, Multicenter Study of 251 Cases ePoster Presentation Mark Zhu, MBChB, NEW ZEALAND Richard Rahardja, MBChB, BMedSc(Hons), NEW ZEALAND Laurens Manning, MBChB, AUSTRALIA Sarah Metcalf, MBChB, NEW ZEALAND Simon W. Young, MD, FRACS, NEW ZEALAND
Influence of Mini Approach Instrumentation on Component Alignment In Unicondylar Knee Replacement ePoster Presentation Vinod Kumar, MBBS, MS, DNB, MNAMS, INDIA Deepak Gupta, MBBS, MS, INDIA Ananya Sharma, MBBS, MS, DNB , INDIA
Changes In CPAK Classification and Its Characteristics before and after Kinematic Alignment TKA ePoster Presentation Manabu Akagawa, MD, PhD, JAPAN ヒデトモサイトウ, MD, PhD, JAPAN Naohisa Miyakoshi, MD, PhD, 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

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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