Is the cost-effectiveness of ASC surgery enhanced or decreased when robots are used?
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Cost-effectiveness to be determined
In the last few years, there has been a move of total hip and total knee arthroplasty by CMS from the inpatient only list that also sparked the development of enhanced recovery programs that have embraced limited stay or same-day surgery.
This move has further shifted procedures, which were normally done in a hospital, to ASCs for selected patients. As the popularity of total joint arthroplasty in ASCs continues to grow nationwide, innovative technology, including robotic-assisted surgery, has also been gaining greater interest. While robotic surgery has the potential for improved accuracy and ultimately improved outcomes, the challenge is that technology comes at a financial cost that needs to be balanced within the program.
In the current health care arena, there is an increased emphasis on efficiency and quality of care while curtailing cost. This becomes a struggle when an ASC is trying to provide a successful program with a high level of patient satisfaction, while managing expenses. Technology is here to stay and will continue to be an integral part of arthroplasty programs. The ultimate benefits of robotic surgery within an ASC will be determined by patient satisfaction and clinical outcomes. As robotic TJA continues to gain momentum and more procedures are performed in an ASC, data will determine whether the initial capital expense is offset by improved outcomes.
Giles R. Scuderi, MD, FAAOS, FACS, is vice president of the Orthopedic Service Line at Northwell Health in New York.
Robotics cost-effective in the ASC
Navigation and robotics in TKA enhances cost efficacy in the ASC setting by 1) improving patient-reported outcome measures (PROMs), which reflects favorably upon the reputation of the facility and its surgeons; 2) reducing reoperations for laxity and loosening, which burden the whole health care system and which will be used to judge the fitness of facilities for participation in bundled contracts and centers of excellence programs; and 3) responding to patients’ understanding of the benefits of technology as they consider major surgery.
The cost of systems can vary considerably. Despite an opaque rebate structure that makes some expensive systems appear “free,” the return on investment is greatest if the ASC chooses the least pricey system that also provides the most useful data. Our group has demonstrated improved PROMs and reduced laxity with one such system. All of the robotic TKA systems today are essentially time-neutral for most surgeons after a short series of cases.
Navigation and robotics in THA are evolving. Advanced systems can predict the adverse consequences of the hip-spine relationship and aid in optimal component positioning. Delivery systems can be robotic or image based. Technology-enabled THA can benefit patients at highest risk for instability. The ASC, thereby, enjoys the same quality, economic and reputational results as are seen with robotic TKA.
Opponents argue that navigation and robotics are solely for marketing, but as arthroplasty moves to the ASC, surgeons can be confident that many advanced technologies provide both patient benefit and cost efficacy.
- References:
- Langston J, et al. Bone Joint J. 2018;doi:10.1302/0301-620X.100B7.BJJ-2017-1599.R1.
- Spencer-Gardner L, et al. Bone Joint J. 2016;doi:10.1302/0301-620X.98B10.37808.
- Wakelin EA, et al. Knee Surg Sports Traumatol Arthrosc. 2021;doi:10.1007/s00167-021-06482-2.
John M. Keggi, MD, is at Orthopaedics New England in Middlebury, Connecticut.
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