Feasibility and Safety of Performing Day-Surgery Medial Unicompartmental Robotic Prostheses in the Italian Health Care System
Authors: Banchetti Roberta 
Published: November 2024

Study Purpose: Our study analyzes the feasibility and safety of robotic-assisted medial unicompartmental prostheses performed in day surgery compared to the current standard for a minimum of two nights in the rules of the Italian National Health System, which is mandatory for Diagnosis Related Groups reimbursement of ordinary hospitalization. Two groups of patients undergoing robotic-assisted medial unicompartmental prostheses were compared, of which one group in ordinary hospitalization and one group in day surgery. All patients from both groups underwent Robot-assisted medial unicompartmental prosthesis surgery (RIO® MAKO Stryker surgical corporation). The terms of comparison between the two groups regarding feasibility and safety were: any complications, any transfusions, hospital readmissions, and ER accesses for prosthesis-related reasons within 7 days and within 3 months after surgery. Pain preoperatively, at discharge, 3 months and 1 year after surgery was quantified by Verbal Rating Scale (0 to 4). Method: At the ASL Toscana Sudest in Arezzo, a total of 280 robot-assisted Unicompartmental Knee Arthroplasty (UKA) surgeries were performed during the study period (2014-2018), 259 of which were medial surgeries. The surgical team was always the same with oversight by two experienced senior surgeons. In this study, 259 cases of medial UKA were taken into consideration, while lateral or patellofemoral types were left out. Of the 259 medial UKA, 30 patients were consecutively operated on in day surgery by waiting list progression without any exclusion. The other 229 were all operated on as inpatients. We collected the ASA (American Society of Anesthesiologists) value data of the 30 patients under study namely 9 patients with ASA 1, 19 patients with ASA 2, and 2 patients with ASA 3. The average time for robotic surgery between the first 30 patients operated in 2014 and the last 30 operated in 2018 was studied to evaluate the trend in reduction of operational time by showing improvement in the learning curve of robotic technique with statistically significant result of P<0.01. We assessed patient satisfaction with the surgical course and outcomes of the 30 patients operated for UKA in day surgery, 3 and 12 months after surgery with Likert scale quantifying satisfaction from 1 to 5: 1 totally dissatisfied, 2 dissatisfied, 3 neutral, 4 satisfied, 5 completely satisfied. Results: No readmission to the emergency room or ward occurred within 7 and 90 days after surgery for minor or major complications in the two groups. In view of the pain treatment protocol adopted for all UKA operated patients, the results regarding pain were not statistically significant between the two groups. Therefore, there were no differences according to the two types of hospitalization. After 3 and 12 months, 80% and 76% of patients, respectively, in the day-surgery operated group expressed themselves with value 4 and 5 on the Likert scale of satisfaction. Conclusions: In our study, we found no differences between the two groups of 30 patients operated in day surgery and the 229 operated in ordinary hospitalization in terms of transfusions, complications or hospital readmissions within 7 days, nor minor or major complications within 90 days after surgery. We found no statistically significant differences in the VRS pain scale by comparing the two groups; we found a high satisfaction index of the 30 patients undergoing day surgery. The pain scale, compared with values between the same group of 30 patients before surgery and after 3 and 12 months, showed a decrease such that it was statistically significant for P<0.05; an analogous result was obtained by comparing values between the same group of 229 patients for P<0.05. Our study demonstrates that robotic medial UKA can be safely performed in day surgery. Being able to perform this surgery under the assumptions and characteristics of day surgery organization means reduction of surgery costs, of waiting lists, of hospitalization risks, and of patient stress. The resulting organizational proposal is to authorize Italian health facilities to perform partial prosthesis surgery in day surgery with equal DRG reimbursement. Economic savings would result from this opportunity by offsetting the higher cost of the same robotic surgery.