Time-Driven Activity-Based Cost Analysis to Decrease Financial Burden of Manipulation Under Anesthesia After Total Knee Arthroplasty.

Abstract

Despite total knee arthroplasty (TKA) being considered one of the most successful orthopaedic procedures, stiffness may lead to dissatisfaction. Manipulation under anesthesia (MUA) is a first-line treatment option for stiffness after TKA. Since patients who have stiffness following TKA often have higher costs, there is a need to understand the cost to the hospital of an MUA. We sought to use time-driven activity-based costing to accurately determine MUA hospital costs. Previously collected financial data of 510 knees in 479 patients who underwent MUA after TKA at a single institution between January 07, 2015, and May 23, 2023, were retrospectively reviewed. Demographics, history of TKA, length of stay, and discharge disposition were included to assess for patient-specific risk factors related to increased cost of MUA. The time-driven activity-based costing costs, including all personnel and supply costs, were calculated and compared to the hospital reimbursement for each patient. The average total cost of an MUA was 1,749.72 dollars ($). Personnel costs accounted for 71.4% of total costs. Commercial insurance plans were associated with a higher cost of MUA (P = 0.048), but age (P = 0.081), sex (P = 0.18), body mass index (P = 0.11), or American Society of Anesthesiologists score (P = 0.88) was not. Mean hospital reimbursement was $1,909.18, and mean hospital revenue was $159.46. The MUAs have substantial hospital costs, with most expenses coming from preoperative testing and procedural personnel costs. The majority of MUAs occurred within the 90-day TKA global payment period, which is important to consider for hospital reimbursement policies.