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Robotic Versus Manual Total Hip Arthroplasty: A Marginal Time-driven Activity-based Costing Analysis
Perry L Lim1, Graham S Goh, Hany S Bedair
1From the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Lim, Bedair, and Melnic), the Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA (Lim, Bedair, and Melnic), and the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Goh).
Background:
Standard cost analyses of robotic total hip arthroplasty (THA) have been done. However, no studies have used time-driven activity-based costing (TDABC), a novel cost calculation method that more accurately reflects true resource utilization in health care. This study aimed to compare healthcare facility costs between robotic and manual THA using TDABC.
Methods:
We conducted a retrospective analysis of 384 consecutive THAs performed between 2019 and 2023. Total healthcare facility costs, comprising personnel and supply costs, were calculated using TDABC. Separate analyses including and excluding implant costs were done. Multiple regression was used to determine the independent effect of robotic assistance on facility costs.
Results:
A total of 384 THAs (190 manual, 194 robotic) were analyzed. Patients undergoing robotic THA had a significant shorter length of stay (1.9 vs. 2.3 days, P = 0.033), but similar surgical times (1.00x, P = 0.936) and total personnel costs ( P = 0.080). Robotic THAs had higher total supply costs and facility costs when including (1.19x, P < 0.001; 1.08, P = 0.017) and excluding (1.91x, P < 0.001; 1.10x, P = 0.013) implant cost. However, when controlling for demographics and comorbidities known to influence costs in arthroplasty, similar total facility costs between robotic and manual THA, when including ( P = 0.095) and excluding ( P = 0.087) implant cost, were noted. A comparison of perioperative outcomes revealed no significant difference in 90-day emergency department visits, 90-day readmissions, 90-day complications, reoperations, or revision surgeries.
Conclusion:
Using TDABC, total healthcare facility costs of robotic THA were similar to those of manual THA when controlling for variables known to influence costs in total joint arthroplasty. This study offers patient-level cost insights on the economic feasibility of robotic THA. Additional studies evaluating the long-term outcomes of robotic THA are needed to determine its long-term advantages.
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