Cost and Patient Outcomes Associated With Bilateral Total Knee Arthroplasty Performed by 2-Surgeon Teams vs a Single Surgeon

Cody C. Wyles, William A. Robinson, Hilal D Maradit Kremers, Matthew T. Houdek, Robert T. Trousdale, Tad M. Mabry

Research output: Contribution to journalArticle

Abstract

Background: Bilateral total knee arthroplasty (TKA) can be performed under a single-anesthetic (SA) or staged under a two-anesthetic (TA) technique. Recently, our institution began piloting a 2-surgeon team SA method for bilateral TKA. The purpose of this study was to compare the inpatient costs and clinical outcomes in the first 90 days after surgery between the team SA, single-surgeon SA, and single-surgeon TA approaches for bilateral TKA. Methods: All primary TKAs performed from 2007 to 2017 by the 2 participating surgeons for each of the 3 groups of interest were identified: team SA (N = 42 patients; 84 knees), single-surgeon SA (N = 146 patients; 292 knees), single-surgeon TA (N = 242 patients; 484 knees). No patients were lost to follow-up. Results: Median hospital cost (per TKA) for the episode(s) of care was as follows: team SA $20,962, single-surgeon SA $22,057, single-surgeon TA $31,145 (P <.001 overall; P =.0905 team SA vs single-surgeon SA). Rate of 90-day complications was 2.4% for team SA, 11.0% for single-surgeon SA, and 8.3% for single-surgeon TA (P =.2090). Discharge to skilled nursing facilities or rehab was as follows: team SA 31%, single-surgeon SA 53%, and single-surgeon TA after the second operation 34% (P <.001). Conclusion: This pilot project suggests that team SA bilateral TKA is a potentially cost-effective option with fewer complications compared to single-surgeon SA bilateral TKA. The less frequent disposition to skilled nursing facilities in the team SA group in conjunction with more efficient operating room utilization may further enhance the financial benefits.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - Jan 1 2019

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Knee Replacement Arthroplasties
Anesthetics
Costs and Cost Analysis
Surgeons
Skilled Nursing Facilities
Knee
Episode of Care

Keywords

  • anesthesia
  • bilateral
  • cost
  • patient outcomes
  • total knee arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Cost and Patient Outcomes Associated With Bilateral Total Knee Arthroplasty Performed by 2-Surgeon Teams vs a Single Surgeon. / Wyles, Cody C.; Robinson, William A.; Maradit Kremers, Hilal D; Houdek, Matthew T.; Trousdale, Robert T.; Mabry, Tad M.

In: Journal of Arthroplasty, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Bilateral total knee arthroplasty (TKA) can be performed under a single-anesthetic (SA) or staged under a two-anesthetic (TA) technique. Recently, our institution began piloting a 2-surgeon team SA method for bilateral TKA. The purpose of this study was to compare the inpatient costs and clinical outcomes in the first 90 days after surgery between the team SA, single-surgeon SA, and single-surgeon TA approaches for bilateral TKA. Methods: All primary TKAs performed from 2007 to 2017 by the 2 participating surgeons for each of the 3 groups of interest were identified: team SA (N = 42 patients; 84 knees), single-surgeon SA (N = 146 patients; 292 knees), single-surgeon TA (N = 242 patients; 484 knees). No patients were lost to follow-up. Results: Median hospital cost (per TKA) for the episode(s) of care was as follows: team SA $20,962, single-surgeon SA $22,057, single-surgeon TA $31,145 (P <.001 overall; P =.0905 team SA vs single-surgeon SA). Rate of 90-day complications was 2.4{\%} for team SA, 11.0{\%} for single-surgeon SA, and 8.3{\%} for single-surgeon TA (P =.2090). Discharge to skilled nursing facilities or rehab was as follows: team SA 31{\%}, single-surgeon SA 53{\%}, and single-surgeon TA after the second operation 34{\%} (P <.001). Conclusion: This pilot project suggests that team SA bilateral TKA is a potentially cost-effective option with fewer complications compared to single-surgeon SA bilateral TKA. The less frequent disposition to skilled nursing facilities in the team SA group in conjunction with more efficient operating room utilization may further enhance the financial benefits.",
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AU - Robinson, William A.

AU - Maradit Kremers, Hilal D

AU - Houdek, Matthew T.

AU - Trousdale, Robert T.

AU - Mabry, Tad M.

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AB - Background: Bilateral total knee arthroplasty (TKA) can be performed under a single-anesthetic (SA) or staged under a two-anesthetic (TA) technique. Recently, our institution began piloting a 2-surgeon team SA method for bilateral TKA. The purpose of this study was to compare the inpatient costs and clinical outcomes in the first 90 days after surgery between the team SA, single-surgeon SA, and single-surgeon TA approaches for bilateral TKA. Methods: All primary TKAs performed from 2007 to 2017 by the 2 participating surgeons for each of the 3 groups of interest were identified: team SA (N = 42 patients; 84 knees), single-surgeon SA (N = 146 patients; 292 knees), single-surgeon TA (N = 242 patients; 484 knees). No patients were lost to follow-up. Results: Median hospital cost (per TKA) for the episode(s) of care was as follows: team SA $20,962, single-surgeon SA $22,057, single-surgeon TA $31,145 (P <.001 overall; P =.0905 team SA vs single-surgeon SA). Rate of 90-day complications was 2.4% for team SA, 11.0% for single-surgeon SA, and 8.3% for single-surgeon TA (P =.2090). Discharge to skilled nursing facilities or rehab was as follows: team SA 31%, single-surgeon SA 53%, and single-surgeon TA after the second operation 34% (P <.001). Conclusion: This pilot project suggests that team SA bilateral TKA is a potentially cost-effective option with fewer complications compared to single-surgeon SA bilateral TKA. The less frequent disposition to skilled nursing facilities in the team SA group in conjunction with more efficient operating room utilization may further enhance the financial benefits.

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