Computer-assisted fluoroscopy-based navigation reduced readmissions after THA
Key takeaways:
- THA with computer-assisted fluoroscopy-based hip navigation resulted in fewer readmissions compared with manual THA.
- Total hospital costs were similar for fluoroscopy-based THA vs. manual THA.
Compared with manual total hip arthroplasty, THA with computer-assisted fluoroscopy-based hip navigation resulted in fewer readmissions, higher rates of discharge to home and similar costs.
Using data from the Premier healthcare database, William G. Hamilton, MD, and colleagues retrospectively analyzed outcomes from 4,080 computer-assisted fluoroscopy-based hip navigation THA procedures and 429,533 manual THA procedures from Jan. 1, 2016, to Sept. 31, 2021. Outcome measures including readmission, OR time, length of stay (LOS), discharge status and hospital costs were analyzed at 90 days and 1 year after surgery.
The navigation cohort had “significantly lower” all-cause and hip-related readmissions at 90 days and 1 year compared with the manual cohort. Hamilton and colleagues noted OR times were longer in the navigation cohort (134.65 minutes) compared with manual cohort (132.04 minutes); however, patients in the navigation cohort had shorter LOS (1.51 days) compared with patients in the manual cohort (1.76 days). Additionally, patients in the navigation cohort were more likely to be discharged home (93.73%) compared with the manual cohort (90.11%). Total hospital costs were $17,124.53 for navigation group and $17,159.24 for the manual group.
“Enhancing intraoperative technique in a manner that improves component positioning has been proposed as a strategy to improve THA outcomes and prevent revision,” Hamilton and colleagues wrote in the study. “Although the use of computer-assisted fluoroscopy-based navigation may require the purchase or leasing of equipment thus increasing initial cost, this cost may be offset by improved patient-centered outcomes and reduced postoperative readmission leading to overall cost-neutral procedures,” they concluded.
Perspective
Back to TopThe investigators utilized a database of patients and compared 4,080 fluoroscopy-navigated total hip replacement to 429,533 manually performed THRs; they found that the fluoroscopy-navigated cohort had a greater OR time, but a lower hip-related readmission rate at 90 and 365 days. Furthermore, they were more likely to be discharged home than the manually performed group.
Fluoroscopically based computer navigation is a method of adding precision to the THR procedure with regard to acetabular component positioning and the equalization of leg lengths. It has the advantage over other navigation systems, such as robotically assisted procedures, by not requiring the radiation, cost and expense of obtaining a preoperative CT scan. The study by William G. Hamilton, MD, and colleagues is the first to examine the potential benefit of this technique upon readmission rates, resource use and costs.
I have been using this technology for primary THR and have found that it has significant benefits to making my surgical results more precise. I am not surprised that the investigators have found a reduction in hip-related readmissions in this group compared to the manually performed group. There was a 30% reduction in the 90-day readmission rate and a 36% reduction in the 365-day readmission rate, which should lead to significantly decreased morbidity for the patients and reduced costs to the health care system.
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Hamilton WG, et al. Expert Review of Medical Devices.2023;doi:10.1080/17434440.2023.2238609.
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