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Corrigendum
2 August 2024

Corrigendum

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In the Systematic Review by Kara Sarrel, Daniel Hameed, Jeremy Dubin, Michael A Mont, David J Jacofsky and Andréa B Coppolecchia, “Understanding economic analysis and cost–effectiveness of CT scan-guided, 3-dimensional, robotic-arm assisted lower extremity arthroplasty: a systematic review”, which appeared in the April 2024 issue of the Journal of Comparative Effectiveness Research (13[4], e230040 [2024]), some errors occurred within the text and Tables, as detailed below. These corrections do not affect the overall conclusions of the article.
Text corrections are as follows:
Original text:Has been corrected to:
• For index UKAs, they found a shorter LOS (1.8 vs 2 days, p = 0.0047), lower index costs ($25,786 vs $26,307, p = 0.05), and a decreased 2-year rate of revision (0.81 vs 5.28%, p = 0.002) for rUKA compared with mUKA.• For index UKAs, they found a shorter LOS (1.8 vs 2 days, p = 0.0047), lower index costs ($25,786 vs $26,307, p > 0.05), and a decreased 2-year rate of revision (0.81 vs 5.28%, p = 0.002) for rUKA compared with mUKA.
• They found a decreased LOS in the rTKA cohort (1.2 vs 1.6 days, p < 0.0001) and overall lower index costs during the hospitalization ($12,356. vs $15,586, p < 0.001) when compared…• They found a decreased LOS in the rTKA cohort (1.2 vs 1.6 days, p < 0.0001) and overall lower index costs during the hospitalization ($14,189 vs $15,586, p < 0.001) when compared…
• They found a shorter LOS in the rTKA cohort compared with mTKA (1.5 vs 1.8 days, p < 0.001)…• They found a shorter LOS in the rTKA cohort compared with mTKA (1.5 vs 1.6 days, p < 0.001)…
• A 2021 paper by Mont et al. [23] utilized data from the Medicare Standard Analytic Files from 2016 to 2017 to evaluate differences in rTKA vs mTKA groups with regards to 90-day EOC costs, discharge dispositions, post-discharge utilizations, and readmissions. When compared with mTKA, they found a lower LOS in the rTKA cohort (1.8 vs 2.5 days, p < 0.0001), decreased index costs during the hospitalization ($12,384 vs $13,024, p = 0.0001), lower post-discharge costs ($5234 vs $6978, p < 0.0001), and lower 90-day EOC costs ($18,568 vs $20,960, p < 0.0001). Fewer patients in the rTKA were discharged to a SNF or inpatient rehabilitation (15.2 vs 28.3%, p < 0.0007), with the average cost of SNF lower in the rTKA cohort as well ($7201 vs $7947, p = 0.0230) vs mTKA. Post-discharge utilization was lower in the rTKA cohort, with 61.3% utilizing home health services with an average cost of $3045 for an average of 11.7 home health visits, compared with 62.7% and $3536 for an average of 14 visits in the mTKA cohort. Patients in the rTKA cohort also had significantly fewer outpatient clinic visits in the first 90 days post-operatively (35.5 vs 42.9%, p < 0.0001). Readmissions were also lower in the rTKA cohort (5.2 vs 7.8%, p = 0.0423). They found a lower, but not statistically significant, 90-day utilization of ED services in the rTKA group (11.2 vs 13.3%, p = 0.1726) compared with mTKA.• A 2021 paper by Mont et al. [23] utilized data from the Medicare Standard Analytic Files from 2016 to 2017 to evaluate differences in rTKA vs mTKA groups with regards to total episode payments, health care utilization, and readmissions, at 30-, 60-, and 90-day time points. When compared with mTKA, they found lower total episode payments in the rTKA cohort at 30 days, US $17,768 versus US$19,899 (p < 0.0001), at 60 days, US$18,174 versus US$20,492 (p < 0.0001), and at 90 days, US$18,568 versus US$20,960 (p < 0.0001). At 30 days, 47% fewer rTKA patients utilized skilled nursing facility (SNF) services (13.5 vs 25.4%; p < 0.0001) and had lower SNF costs at 30 days (US$6,416 vs US$7,732; p = 0.0040), 60 days (US$6,678 vs US$7,901, p = 0.0072), and 90 days (US$7,201 vs US$7,947, p = 0.0230). rTKA patients also utilized fewer home health visits and costs at each time point (p < 0.05). Additionally, 31.3% fewer rTKA patients utilized emergency room services at 30 days postoperatively and had 90-day readmissions (5.20 vs 7.75%; p = 0.0423).
• This study reported on a subset of patients undergoing primary THA from 2008 to 2017.• This study reported on a subset of patients undergoing primary THA from 2008 to 2018.
• Of note, this study also found in-hospital THA dislocation to be lower in the rTHA cohort compared with mTHA (0.1 vs 0.8%, p < 0.001), as well as lower minor perioperative complications (12.8 vs 21.6%, p = 0.004).• Of note, this study also found lower rates of THA dislocation (0.1 vs 0.8, p < 0.001), minor perioperative complications (12.8 vs 21.6%, p = 0.004 and implant related mechanical complications (0.5 vs 3.1%, p < 0.001) for rTHA compared to mTHA.
• This study also evaluated in-hospital post-operative complications and found a lower rate of major complications in the rTHA cohort (2.2 vs 3.3%, p < 0.001), and lower rates of in-hospital implant-related mechanical complications (0.5 vs 3.1%, p < 0.001).• This study also evaluated in-hospital post-operative complications and found no significant difference in the odds of experiencing either a major or a minor complication.
• Compared with mTHA, LOS was lower in the rTHA cohort (2.3 vs 2.5 days, p = 0.0137), and fewer patients in the rTHA cohort were discharged to a SNF (27.1 vs 35.6%). In addition, rTHA patients spent fewer days at a SNF (18 vs 19.6 days), which amounted to a $1224 average cost savings compared with mTHA. Total overall costs of home health services were lower in the rTHA cohort ($3352 vs $3496).• Compared with mTHA, LOS was lower in the rTHA cohort (2.3 vs 2.5 days, p = 0.0137), and fewer patients in the rTHA cohort were admitted to a SNF (20.8 vs 25.0%). In addition, rTHA patients spent fewer days at a SNF (18 vs 19.6 days), which amounted to a $1224 average cost savings compared with mTHA. Total overall costs of home health services were lower in the rTHA cohort ($3352 vs $3496).
• … found lower cumulative costs for rTHAs compared with mTHAs, for both Medicare ($14,811 ± 40 vs $16,189 ± 115) and private payor scenarios ($15, 212 ± 82 vs $17,022 ± 204).• … found lower cumulative costs for rTHAs compared with mTHAs, for both Medicare ($14,410 ± 40 vs $15,355 ± 115) and private payor scenarios ($15, 212 ± 82 vs $17,022 ± 204).
• In a 2022 retrospective study, Kolessar et al. [19] evaluated a series of 178 patients (6 mUKAs, 19 rUKAs, 58 mTKAs, and 85 rTKAs)…• In a 2022 retrospective study, Kolessar et al. [19] evaluated a series of 178 patients (6 mUKAs, 29 rUKAs, 58 mTKAs, and 85 rTKAs)…
• Robotic-arm assisted UKA patients had increased operating times (86 vs 75.9 min, p = 0.004), but a lower length of stay (1.8 vs 4.8 days, p < 0.001).• Robotic-arm assisted UKA patients had increased operating times (86 vs 75.9 min, p = 0.004), but a lower length of stay (1.8 vs 4.5 days, p < 0.001).
In addition, Tables 2–6 were published with errors. The correct tables are shown here:
Table 2. CT Scan-guided, 3-dimensional, robotic-arm assisted unicompartmental knee arthroplasty.
 Cool et al. (2019)Clement et al. (2019)
 MRMR
Robotic system cost inclusionN/ANoN/AYes
CT-scan cost inclusionN/ANoN/AYes
Total (n)492246--
LOS2 days1.8 days  
In hospital costs$26,307$25,786  
Post D/C costs    
90-day EOC cost    
Use of HH services (%)    
HH visits (n)    
Cost of home health    
Outpatient rehab costs    
Revision (1 year)5.3%0.8%1.1%0.5%
Increase in QALYs  1.391.80
$/QALY   $1170$1395
D/C: Discharge; ED: Emergency department; EOC: Episode of care; HH: Home healthcare; ICER: Incremental cost-effectiveness ratio; LOS: Length of stay; M: Manual; QALY: Quality-adjusted life-year; R: Robot; SNF: Skilled nursing facility.
Table 3. CT scan-guided, 3-dimensional, robotic-arm assisted total knee arthroplasty.
 Cotter et al. (2020)Mont et al. (2021)Pierce et al. (2020)Cool et al. (2019)Tompkins et al. (2022)Fang et al. (2022)
CategoryMRMRMRMR MRMR
Robotic system cost inclusionN/A YesN/ANoN/ANoN/ANoN/AYesN/ANo
CT scan cost inclusionN/A NoN/ANoN/ANoN/ANoN/ANoN/ANo
Total (n)139147259551917853572595519239223921795263
LOS1.61.22.51.82.71.82.51.81.841.762.11.8
In-hospital costs$15,586$14,189$13,024$12,384$24,069$21,347$13,024$12,384$16,330$21,006X1.1X
Post D/C costs$2134$1441$6978$5234$8189$6857$6978$5234    
90-day EOC cost$17,721$15,630$20,960$18,568$32,253$28,204$20,960$18,568    
Discharge to SNF/rehab8.6%4.1%28.3%15.22%6.1%1.7%28.2%15.2%5.0%5.0%6.3%1.5%
Cost of SNF  $7947$7201$7849$6269      
Use of HH services  62.7%61.3%69.2%67.0%  29.0%38.0%  
HH visits (n)  1411.76.45.314.311.9    
Cost of home health  $3536$3045$2038$2009$3536$3045    
Outpatient rehab costs$746$802  $2494$2272      
Readmission within 90 days4.3%2.7%7.8%5.2%3.9%2.2%7.8%5.2%4.9%1.2%  
Average readmission costs$305$73.37  $24,289$13,328$9696$10,570    
Utilizing emergency department (ED) in 90 days post D/C7.9%8.8%13.3%11.2%9.0%9.0%13.3%11.20%    
ED costs in 90 days post D/C$147$57$736$614$4179$7033$736$614    
In-hospital periprosthetic fracture0.7%0.0%          
D/C: Discharge; ED: Emergency department; EOC: Episode of care; HH: Home healthcare; ICER: Incremental cost-effectiveness ratio; LOS: Length of stay; M: Manual; PPFx: Periprosthetic fracture; QALY: Quality-adjusted life-year; R: Robot; SNF: Skilled nursing facility.
Table 4. CT scan-guided, 3-dimensional, robotic-arm assisted total knee arthroplasty.
 Rajan et al. (2022)Ong et al. (2022)Gregory et al. (2022)Grosso et al. (2022)Hua et al. (2022)
CategoryMRMRMRMRMR
Robotic system cost inclusionN/AYesN/ANoN/ANoN/AYesN/AYes
CT scan cost inclusionN/AYesN/ANoN/AYesN/ANoN/ANo
Total (n)  371074241354135460460  
LOS  1.911.561.981.741.61.5  
In-hospital costs $34,509$32,747$31,280$29,984  $28,737$33,581
Post D/C costs  $6949$6513$7728$7189$6983$4066$2397$1618
90-day EOC cost  $41,458$39,260$39,008$37,174$20,608$17,777$31,134$32,018
Discharge to SNF/rehab (%)      12.25.9  
Cost of SNF    $135$91    
Use of HH services  72%68.5%      
HH visits (n)          
Cost of home health  $1394$1354$374$404    
Outpatient rehab costs  $3151$1865      
Readmission within 90 days  15%14.8%  2.39%2.83%  
Average readmission costs    $2137$1781    
Total discounted cost        $31,917$32,535
Revision (1 year)0.8%0.3%0.7%0.3%      
In-hospital PPFx  0.03%0.0%      
Increase in QALYs13.2913.55      6.176.18
ICER - R ($/QALY) $15,685       $41,331
D/C: Discharge; ED: Emergency department; EOC: Episode of care; HH: Home healthcare; ICER: Incremental cost-effectiveness ratio; LOS: Length of stay; M: Manual; PPFx: Periprosthetic fracture; QALY: Quality-adjusted life-year; R: Robot; SNF: Skilled nursing facility.
Table 5. CT scan-guided, 3-dimensional, robotic-arm assisted total hip arthroplasty.
 Emara et al. (2021)Kirchner et al. (2021)Pierce et al. (2021)Clement et al. (2022)Barsoum et al. (2022)
CategoryMRMRMRMRMR
Robotic system cost inclusionN/ANoN/ANoN/ANoN/AYesN/ANo
CT scan cost inclusionN/ANoN/ANoN/ANoN/AYesN/AYes
Total (n)128,35632,09275875846709385124886601732
LOS2.32.22.82.72.52.3  1.71.5
In-hospital costs$17,266$18,416$18,258$20,046$12,665$12,827$32,804$31,507
Post D/C costs    $7854$6907  $4205$3929
90-day EOC cost    $20,519$19,734  $37,009$35,436
Discharge to SNF/rehab18.5%17.4%  27.7%20.8%  
Use of HH services    64.9%72.9%  
Cost of home health    $3496$3352  
Utilizing ED in 90 days post D/C  13.5%13.6%    
ED costs in 90 days post D/C    $786$715    
Revision (1 year)      0.40%0.40%  
In-hospital PPFx0.5%0.2%        
Increase in QALYs       1.06  
ICER - R ($/QALY)       £1432  
D/C: Discharge; ED: Emergency department; EOC: Episode of care; HH: Home healthcare; ICER: Incremental cost-effectiveness ratio; LOS: Length of stay; M: Manual; PPFx: Periprosthetic fracture; QALY: Quality-adjusted life-year; R: Robot; SNF: Skilled nursing facility.
Table 6. Other comparison studies.
 Kolessar et al. (2022)Varughese et al. (2022)
CategoryUKA (M)UKA (R)TKA (M)TKA (R)UKA (R)TKA (M)
Robotic system cost inclusionN/ANoN/ANoNoN/A
CT-scan cost inclusionN/AYesN/AYesYesN/A
Total (n)6195885120120
LOS1.61.41.81.8  
In-hospital costs$3287$4025$4087$4668$12,020$19,199
90-day EOC cost$1239$1051$1602$1196  
Use of HH services83.0%17.0%29.0%6.0%  
HH visits (n)55175  
Cost of home health$609$241    
Outpatient rehab costs  $482$137  
Opioids - R UKA (ME)    125 
Opioids - M TKA (ME)     522.1
D/C: Discharge; ED: Emergency department; EOC: Episode of care; HH: Home healthcare; ICER: Incremental cost-effectiveness ratio; LOS: Length of stay; M: Manual; ME: Morphine equivalents; PPFx: Periprosthetic fracture; QALY: Quality-adjusted life-year; R: Robot; SNF: Skilled nursing facility; TKA: Total knee arthroplasty; UKA: Unicompartmental knee arthroplasty.
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