Lengths of Stay and Discharge Dispositions after Total Knee Arthroplasty: A Comparison of Robotic-Assisted and Manual Techniques

2021 ◽  
Author(s):  
Allison Archer ◽  
Hytham S. Salem ◽  
Andrea Coppolecchia ◽  
Michael A. Mont
Keyword(s):  
Length Of Stay ◽  
Large Scale ◽  
Early Discharge ◽  
Robotic Assisted ◽  
Lengths Of Stay ◽  
Home Health Services ◽  
Scale Population ◽  
Manual Group ◽  
Total Knee ◽  
The Mean

AbstractAs evidence signifies that short-stay total knee arthroplasties (TKA) can be safe options, it is important to identify factors that contribute to early discharge. There is evidence that robotic-assisted TKAs may lead to shorter lengths of postoperative stays. However, this has not been evaluated as the primary outcome of interest in a large-scale population. The purpose of this study was to compare manual and robotic-assisted TKAs with regard to: (1) length of stay (LOS) and (2) discharge dispositions. TKAs performed between January 1, 2018, to March 31, 2019, were identified. After applying inclusion and exclusion criteria, a total of 10,296 patients were included: 5,993 in the manual and 4,303 in the robotic-assisted group. Length of stay, discharge dispositions, and Charlson comorbidity indices (CCIs) were recorded for all patients. The mean LOS was significantly lower in robotic-assisted (1.68 ± 0.86 days) compared with manual (1.86 ± 0.94 days) TKA procedures (p < 0.00001). In the robotic-assisted group, 2,049 (47.6%) were discharged in 1 day or less compared with 2,325 (38.8%) in the manual group (p < 0.0001). The proportion discharged home was significantly higher for patients who underwent robotic-assisted (91.3%) compared with manual (87.4%) TKAs (p < 0.00001). When comparing only patients who were discharged home and who did not have home health services, the rate was 51.8% in the robotic-assisted group compared with 44.0% in the manual group (p < 0.00001). The mean CCI was similar for patients who underwent robotic-assisted (2.9 ± 1.4 points) compared with manual (3.0 ± 1.5 points) TKAs. There was a trend toward shorter mean LOS for robotic-assisted versus manual TKA at 17 of the 24 included hospital sites (70.8%). Compared with manual, robotic-assisted TKAs demonstrated shorter lengths of postoperative stays and less need for skilled care after discharge. These results suggest the health care burden resulting from an upsurge of TKA procedures in our aging population might be addressed in part by increased utilization of robotic assistance.

A High-Fidelity Model to Predict Length of Stay in the Neonatal Intensive Care Unit

2021 ◽  
Author(s):  
Kanix Wang ◽  
Walid Hussain ◽  
John R. Birge ◽  
Michael D. Schreiber ◽  
Daniel Adelman
Keyword(s):  
Length Of Stay ◽  
Clinical Data ◽  
Neonatal Intensive Care ◽  
Large Scale ◽  
Expert Knowledge ◽  
Clinical Analysis ◽  
Healthcare Operations ◽  
Lengths Of Stay ◽  
Health Trajectories ◽  
Widespread Implementation

Having an interpretable, dynamic length-of-stay model can help hospital administrators and clinicians make better decisions and improve the quality of care. The widespread implementation of electronic medical record (EMR) systems has enabled hospitals to collect massive amounts of health data. However, how to integrate this deluge of data into healthcare operations remains unclear. We propose a framework grounded in established clinical knowledge to model patients’ lengths of stay. In particular, we impose expert knowledge when grouping raw clinical data into medically meaningful variables that summarize patients’ health trajectories. We use dynamic, predictive models to output patients’ remaining lengths of stay, future discharges, and census probability distributions based on their health trajectories up to the current stay. Evaluated with large-scale EMR data, the dynamic model significantly improves predictive power over the performance of any model in previous literature and remains medically interpretable. Summary of Contribution: The widespread implementation of electronic health systems has created opportunities and challenges to best utilize mounting clinical data for healthcare operations. In this study, we propose a new approach that integrates clinical analysis in generating variables and implementations of computational methods. This approach allows our model to remain interpretable to the medical professionals while being accurate. We believe our study has broader relevance to researchers and practitioners of healthcare operations.

scholarly journals Comparable surgery time for robotic assisted total knee arthroplasty after initial learning curve

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0031
Author(s):  
Peter Savov ◽  
Lars-René Tücking ◽  
Henning Windhagen ◽  
Max Ettinger
Keyword(s):  
Learning Curve ◽  
Robotic System ◽  
Robotic Group ◽  
Absolute Deviation ◽  
Robotic Assisted ◽  
Time Of Surgery ◽  
Implant Positioning ◽  
Initial Learning ◽  
Manual Group ◽  
The Mean

Aims and Objectives: In the past years, further development in knee replacement still continues. Computer-assisted surgery techniques in total knee arthroplasty (TKA) are on the rise. One point of criticism is the prolonged time of surgery and associated cost as known from old techniques like navigation. The primary objective of this study was to determine the learning curve for the time of surgery and accuracy in implant positioning for an imageless robotic system for TKA. Materials and Methods: In this prospective study, the first 30 robotic-assisted TKA from a single senior surgeon were analyzed with regard to time of surgery and accuracy of implant position on the basis of the intraoperative plan and the postoperative x-rays. This data was compared to the last 30 manual TKAs of the same surgeon with the same prosthesis. Evaluation of the learning curve was performed with CUSUM analysis. The time of surgery after finishing the learning curve in the robotic group was compared to the manual group. Results: The learning curve in the robotic group for surgery time was finished after 11 cases. The robotic experience did not affect the accuracy of implant positioning, such as limb alignment and restoration of the joint line. The mean absolute deviation of the postoperative limb alignment to the intraoperative plan was 2° (+/- 1,1). The mean absolute deviation of the medial proximal tibial (mPTA) and distal lateral femoral angle (dLFA) was 1° (+/- 0,9) for both. The mean surgery time in the robotic group after finishing the learning curve was 66 minutes (+/- 4,2) and in the total manual group 67 minutes (+/- 3,5) (n.s.). Conclusion: After finishing the initial learning curve of 11 cases for robotic-assisted TKA the time of surgery is equal to the manual conventional technique. However, there is no learning curve for implant positioning with the imageless robotic system. The implementation of the intraoperative plan is accurate to 1° with the robotic system.

Robotic versus Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

2018 ◽  
Vol 13 (5) ◽  
pp. 338-343 ◽  
Author(s):  
Kelsey A. Musgrove ◽  
Jeremiah A. Hayanga ◽  
Sari D. Holmes ◽  
Alexander Leung ◽  
Ghulam Abbas
Keyword(s):  
Length Of Stay ◽  
Thoracic Surgery ◽  
Early Experience ◽  
Robotic Group ◽  
Robotic Assisted ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted ◽  
Surgery Group ◽  
Small Series ◽  
The Mean

Objective Pulmonary segmentectomy using robotic assistance is often perceived as being more expensive than segmentectomy using video-assisted thoracic surgery. The robotic technique allows for meticulous dissection during segmentectomy, potentially leading to fewer parenchymal injuries, fewer air leaks, and shorter length of stay. This study compared pulmonary segmentectomy costs using video-assisted thoracic surgery versus robotic with manual staplers versus robotic with robotic staplers. Methods Retrospective analyses were performed evaluating our early experience with robotic pulmonary segmentectomy for 30 months compared with the video-assisted thoracic surgery approach. All 50 anatomical segmentectomies performed since introduction of robotic technique in the practice were included. Twenty-eight procedures were robotic-assisted and 22 were video-assisted thoracic surgery. Procedure-specific evaluation of direct costs was performed, including cost of robotic instruments, staplers, and average length of stay in the hospital. Results The mean ± SD age was 70 ± 10 years (range = 43–91 years). There were 12 males in the robotic group and eight in the video-assisted thoracic surgery group ( P = 0.642). The mean age was 69 years in the robotic group and 71 years in the video-assisted thoracic surgery group ( P = 0.367). The median length of stay was 2 (2–4) days in the robotic group (range = 1–9) and 4 (2–5) days in the video-assisted thoracic surgery group (range = 1–20, P = 0.089). The cost of robotic segmentectomy with manual staplers was less than that with robotic staplers. Both robotic techniques cost less than video-assisted thoracic surgery. Conclusions In this small series, cost and outcomes in our early experience with robotic-assisted segmentectomy were comparable with our video-assisted thoracic surgery approach with trends toward shorter length of stay and fewer complications. Larger series are needed to validate these results.

scholarly journals Dalbavancin in real life: Economic impact of prescription timing in French hospitals

2021 ◽  
Author(s):  
Guillaume Beraud ◽  
Jean-Claude Maupetit ◽  
Audric Darras ◽  
Alexandre Vimont ◽  
Martin Blachier
Keyword(s):  
Length Of Stay ◽  
Budget Impact ◽  
Infection Type ◽  
Real Life ◽  
Venous Catheter ◽  
Early Discharge ◽  
Discharge Summary ◽  
National Database ◽  
Lengths Of Stay ◽  
Joint Infections

Objectives: The extended half-life of dalbavancin justifies a once-a-week dosing schedule and is supposed to favour early discharge. These advantages may therefore compensate for the cost of dalbavancin. We aimed to assess the real-life budget impact of dalbavancin through its impact on the length of stay in French hospitals. Methods: A multicentre cohort based on the French registry of dalbavancin use in 2019 was compared to the French national discharge summary database. Lengths of stay and budget impact related to the infection type, the time of introduction of dalbavancin, the type of catheter and patient subgroups were assessed. An early switch was defined when dalbavancin was administered as the first or second treatment and within less than 11 days of hospitalization. Results: One hundred seventy-nine patients were identified in the registry, and 154 were included in our study. Dalbavancin is mostly used for bone and joint infections, infective endocarditis and acute bacterial skin and skin structure infections. When compared to the data for similar patients in the national database, the length of stay was almost always shorter for patients treated with dalbavancin. The budget impact for dalbavancin was heterogeneous but frequently generated savings. Early switching was associated with savings (or lesser costs). Patients who required a deep venous catheter and those with the most severe patients benefited the most from dalbavancin. Conclusions: Our study confirms that dalbavancin is associated with early discharge, which can offset its cost and generate savings. The greatest benefit is achieved with an early switch.

Successful Transition to Robotic-Assisted Lobectomy With Previous Proficiency in Thoracoscopic Lobectomy

2019 ◽  
Vol 14 (3) ◽  
pp. 263-271 ◽  
Author(s):  
Robert E. Merritt ◽  
Peter J. Kneuertz ◽  
Desmond M. D’Souza
Keyword(s):  
Length Of Stay ◽  
Lymph Nodes ◽  
Learning Curve ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Robotic Assisted ◽  
Thoracoscopic Lobectomy ◽  
Surgeon Experience ◽  
The Mean

Objective The learning curve and the advantages of transitioning to robotic-assisted lobectomy by a surgeon who is proficient in thoracoscopic lobectomy is currently unknown. The cost of robotic lobectomy has been reported to be higher than thoracoscopic lobectomy and there is no significant decrease in hospital length of stay. Methods This is a retrospective review of 228 patients diagnosed with lung carcinoma who underwent minimally invasive lobectomy from March 2014 to May 2018. A total of 114 patients underwent thoracoscopic lobectomy and 114 patients underwent robotic-assisted lobectomy. The data collected included patient demographics, tumor characteristics, morbidity, mortality, operative times, and hospital length of stay. Results A total of 114 patients underwent thoracoscopic lobectomy and 114 patients underwent robotic-assisted lobectomy. The patients in each group were similar in age, gender, smoking status, FEV-1, tumor histology, and pathologic stage. The mortality and complication rates were similar. The mean number of total lymph nodes and N2 lymph nodes were significantly higher in the robotic lobectomy group ( P < 0.0001). The mean operative time was shorter in the robotic group. The median hospital length of stay (4 days) was similar between the 2 groups ( P = 0.99). Conclusion The results of this report suggest that thoracoscopic and robotic-assisted lobectomy have similar outcomes when a surgeon proficient in the thoracoscopic technique completely transitions to the robotic-assisted technique. The learning curve was relatively accelerated in this single-surgeon experience. There may be an advantage for robotic-assisted lobectomy in the total number of lymph nodes harvested.

scholarly journals Analyzing the Burden of Revision Total Knee Arthroplasty in the United States between 2009 and 2016

2021 ◽  
Author(s):  
Isaac Livshetz ◽  
Benjamin H. Sussman ◽  
Vivian Papas ◽  
Nequesha S. Mohamed ◽  
Hytham S. Salem ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
International Classification Of Diseases ◽  
The United States ◽  
Revision Total Knee Arthroplasty ◽  
Lower Percentage ◽  
Multivariate Logistic Regression Model ◽  
Lengths Of Stay ◽  
Total Knee ◽  
The Mean ◽  
Hospital Characteristics

AbstractAs the number of total knee arthroplasties (TKAs) increases, it is reasonable to expect the number of revision TKAs (rTKAs) to rise in parallel. The patient-related and societal burdens of rTKA are poorly understood. Therefore, the purpose of this study was to determine temporal changes in: (1) the incidence of rTKA; (2) patient and hospital characteristics; (3) complications, hospital lengths of stay (LOSs), and discharge dispositions; and (4) costs, charges, and payer types. All patients who underwent rTKA between 2009 and 2016 were identified from the National Inpatient Sample database using International Classification of Diseases, Ninth Revision and Tenth Revision codes and were studied. Univariate analyses were performed to compare the incidence of rTKA, patient and hospital characteristics, LOS and discharge dispositions, as well as costs, charges, and payer types. A multivariate logistic regression model was built to compare the odds of complications in 2009 and 2016. Over our study period, there was a 4.3% decrease in the incidence of rTKA. The mean age of patients who underwent rTKA was 65 years and a majority were female (58%). Mean hospital LOS decreased from 4.1 days in 2009 to 3.3 days in 2016 (p < 0.001). The rate of several complications decreased significantly over our study period including myocardial infarction, cardiac arrest, transfusion, pneumonia, urinary tract infection, and mortality. A significantly lower percentage of rTKA patients were discharged to a skilled nursing facility in 2016 (26.5%) compared with 2009 (31.6%; p < 0.001). There was an 18.7% increase in the mean costs, and a 43.3% increase in the mean charges (p < 0.001). Over the study period, there was a decrease in the incidence of rTKAs. Despite potential improvements in primary TKA, the burden associated with rTKA remains large. This report can be used to help educate medical providers about outcomes that may result from a primary and/or revised TKA.

scholarly journals Diagnostic test utilization in the emergency department for alert headache patients with possible subarachnoid hemorrhage

CJEM ◽  
2002 ◽  
Vol 4 (05) ◽  
pp. 333-337 ◽  
Author(s):  
Jeffrey J. Perry ◽  
Ian Stiell ◽  
George Wells ◽  
Alena Spacek
Keyword(s):  
Emergency Department ◽  
Subarachnoid Hemorrhage ◽  
Length Of Stay ◽  
Tertiary Care ◽  
Diagnostic Testing ◽  
Clinical Decision ◽  
Lengths Of Stay ◽  
Level Of Consciousness ◽  
The Mean ◽  
Acute Headache

ABSTRACT: Objectives: This study evaluated the incidence of subarachnoid hemorrhage (SAH) and the use of computed tomography (CT) and lumbar puncture (LP) in a cohort of emergency department (ED) patients with acute headache. Methods: Health records from a tertiary care ED were used to identify all patients over 15 years of age who presented with headache over a 10-month period. Patients were excluded if they had been referred with confirmed SAH or if they had recurrent headache, head trauma, decreased level of consciousness or new neurologic deficits. Outcome measures included ED diagnosis, use of CT or LP, and ED length of stay. Analysis included descriptive statistics, 95% confidence intervals (CIs) and analysis of variance for length of stay. Results: The mean age of the 891 patients was 41.9 years. Ten (1.1%) of the patients had SAH, 313 (35.1%) underwent CT, and 85 (9.5%) underwent LP. Only 9 (2.9%) of the CT scans and 2 (2.4%) of the LPs were positive for SAH. Of the 296 patients with normal CT results, 232 (78.4%) did not undergo subsequent LP. The mean length of stay was 4.0 hours (95% CI, 3.8–4.1) if no diagnostic testing was performed, 5.0 hours (95% CI, 4.7–5.4) if CT was performed and 7.1 hours (95% CI, 6.3–7.9) if LP was performed (p = 0.001). Conclusions: Diagnostic testing was associated with substantially prolonged lengths of stay. CT and LP had low diagnostic yields, which suggests the need for a clinical decision rule to rule out SAH in ED patients with acute headache.

Use, Cost, Complications, and Mortality of Robotic versus Nonrobotic General Surgery Procedures Based on a Nationwide Database

2013 ◽  
Vol 79 (6) ◽  
pp. 553-560 ◽  
Author(s):  
Muhammad Salman ◽  
Theodore Bell ◽  
Jennifer Martin ◽  
Kalpesh Bhuva ◽  
Rod Grim ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Length Of Stay ◽  
General Surgery ◽  
New Technology ◽  
Cost Effective ◽  
Robotic Assisted ◽  
Setup Costs ◽  
Lengths Of Stay ◽  
Surgeon Training ◽  
The Cost

Since its introduction in 1997, robotic surgery has overcome many limitations, including setup costs and surgeon training. The use of robotics in general surgery remains unknown. This study evaluates robotic-assisted procedures in general surgery by comparing characteristics with its nonrobotic (laparoscopic and open) counterparts. Weighted Healthcare Cost and Utilization Project Nationwide Inpatient Sample data (2008, 2009) were used to identify the top 12 procedures for robotic general surgery. Robotic cases were identified by Current Procedural Terminology codes 17.41 and 17.42. Procedures were grouped: esophagogastric, colorectal, adrenalectomy, lysis of adhesion, and cholecystectomy. Analyses were descriptive, t tests, χ2s, and logistic regression. Charges and length of stay were adjusted for gender, age, race, payer, hospital bed size, hospital location, hospital region, median household income, Charlson score, and procedure type. There were 1,389,235 (97.4%) nonrobotic and 37,270 (2.6%) robotic cases. Robotic cases increased from 0.8 per cent (2008) to 4.3 per cent (2009, P < 0.001). In all subgroups, robotic surgery had significantly shorter lengths of stay (4.9 days) than open surgery (6.1 days) and lower charges (median $30,540) than laparoscopic ($34,537) and open ($46,704) surgery. Fewer complications were seen in robotic-assisted colorectal, adrenalectomy and lysis of adhesion; however, robotic cholecystectomy and esophagogastric procedures had higher complications than nonrobotic surgery ( P < 0.05). Overall robotic surgery had a lower mortality rate (0.097%) than nonrobotic surgeries per 10,000 procedures (laparoscopic 0.48%, open 0.92%; P < 0.001). The cost of robotic surgery is generally considered a prohibitive factor. In the present study, when overall cost was considered, including length of stay, robotic surgery appeared to be cost-effective and as safe as nonrobotic surgery except in cholecystectomy and esophagogastric procedures. Further study is needed to fully understand the long-term implications of this new technology.

Does Increasing Patient Complexity Have an Effect on Medical Outcomes and Lengths-of-Stay after Total Knee Arthroplasty?

2020 ◽  
Author(s):  
Hiba K. Anis ◽  
Nipun Sodhi ◽  
Alexander J. Acuña ◽  
Alexander Roth ◽  
Rushabh Vakharia ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Medical Complications ◽  
Study Cohort ◽  
Control Cohort ◽  
Lengths Of Stay ◽  
Comorbidity Burden ◽  
Total Knee ◽  
The Mean ◽  
And Gender

AbstractA greater number of medically complex patients with multiple comorbidities are now more readily considered for total knee arthroplasty (TKA). Therefore, the purpose of this study was to determine whether comorbidity burden, measured with the Elixhauser Comorbidity Index (ECI), correlated with 90-day medical complications and longer in-hospital lengths-of-stay (LOS) in TKA patients. The PearlDiver supercomputer was queried for all primary TKA patients in the Medicare Standard Analytic Files from 2005 to 2014 using International Classification of Disease, 9th edition codes. Patients were included based on ECI scores, ranging from 1 to 5. ECI 1 patients served as the control cohort, while ECI 2, 3, 4, and 5 patients were considered study cohorts. Each study cohort was matched based on age and gender to the control cohort, resulting in a total of 715,398 patients included for analysis (ECI 1, n = 144,072; ECI 2, n = 144,072; ECI 3, n = 144,072; ECI 4, n = 144,072; ECI 5, n = 139,110). Logistic regression analyses were performed to compare 90-day medical complications and Welch's t-tests were performed to compare LOS between the cohorts. Patients with higher ECI scores were more likely to develop medical complications and have longer LOS compared with matched patients in the control cohort. Compared with matched ECI 1 patients, patients with ECI scores of 2 (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.14–1.24), 3 (OR: 1.27, 95% CI: 1.21–1.32), 4 (OR: 1.32, 95% CI: 1.27–1.38), and 5 (OR: 1.33, 95% CI: 1.27–1.39) were significantly more likely to develop 90-day medical complications. Additionally, the mean LOS of patients in the ECI 2 (2.59 ± 1.49 vs. 2.73 ± 1.52 days), ECI 3 (2.59 ± 1.49 vs. 2.88 ± 1.51 days; p < 0.001), ECI 4 (2.59 ± 1.49 vs. 3.01 ± 1.56 days; p < 0.001), and ECI 5 (2.61 ± 1.49 vs. 3.14 ± 1.61 days; p < 0.001) groups were significantly longer than the mean LOS in the control ECI 1 group. In an increasingly complex patient population, associations between comorbidities and outcomes after TKA procedures can guide providers on how to modify their pre- and postoperative care. These results demonstrate that higher ECI scores are associated with a greater likelihood of 90-day medical complications and longer in-hospital LOS.

Learning Curve of Robotic-Assisted Total Knee Arthroplasty for a High-Volume Surgeon

2020 ◽  
Author(s):  
Kevin B. Marchand ◽  
Joseph Ehiorobo ◽  
Kevin K. Mathew ◽  
Robert C. Marchand ◽  
Michael A. Mont
Keyword(s):  
Total Knee Arthroplasty ◽  
Learning Curve ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
High Volume ◽  
Study Groups ◽  
P Value ◽  
Robotic Assisted ◽  
Total Knee ◽  
The Mean

AbstractThe learning curve has been established for robotic-assisted total knee arthroplasty (RATKA) during the first month of use; however, there have been no studies evaluating this on a longer term. Therefore, the purpose of this study was to compare operative times for three cohorts during the first year following adoption of RATKA (initial, 6 months, and 1 year) and a prior cohort of manual TKA. We investigated both mean operative times and the variability of operative time in each cohort. This is a learning curve study comparing a single surgeon's experience using RAKTA. The study groups were made up of two cohorts of 60 cementless RATKAs performed at ∼6 months and 1 year of use. A learning curve was created based on the mean operative times and individual operative times were stratified into different cohorts for comparison. Study groups were compared with the surgeon's initial group of 20 cemented RATKAs and 60 cementless manual cases. Descriptive numbers were compiled and mean operative times were compared using Student's t-tests for significant differences with a p-value of < 0.05. The mean surgical times continued to decrease after 6 months of RATKA. In 1 year, the surgeon was performing 88% of the RATKA between 50 and 69 minutes. The initial cohort and 1-year robotic-assisted mean operative times were 81 and 62 minutes, respectively (p < 0.00001). Mean 6-month robotic-assisted operative times were similar to manual times (p = 0.12). A significant lower time was found between the mean operative times for the 1-year robotic-assisted and manual (p = 0.008) TKAs. The data show continued improvement of operative times at 6 months and 1 year when using this new technology. The results of this study are important because they demonstrate how the complexity of a technology which initially increases operative time can be overcome and become more time-effective than conventional techniques.

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