Work

The hospital cost of primary reverse total shoulder arthroplasty performed with traditional instrumentation: a Time-Driven Activity-Based Costing (TDABC) benchmark analysis in the era of digital enabling technology

Year: 2026

Type: article

Abstract: Background: There is increasing interest in the use of digital enabling technology, and particularly robotic-assisted surgery, to perform reverse total shoulder arthroplasty (rTSA). However, a major concern with the adoption of digital enabling technology is the potential for increased cost, related not only to the capital cost of acquisition and disposables but also to longer procedure times. Time-Driven Activity-Based Costing (TDABC) was developed to calculate the true cost of healthcare by meticulously tracking the resources and time consumed during each step of a patient's hospital journey. The purpose of this study was to apply TDABC and traditional costing to analyze the costs of rTSA performed with traditional instrumentation in order to establish a benchmark for future comparison with new technologies. Methods: Twenty-five primary rTSA performed at a single high-volume institution in the United States in 2025 were included in this prospective TDABC study. A detailed process map of all pre-operative, intraoperative, and post-operative activities patients underwent from hospital admission to same-day hospital discharge was created. A single observer followed all 25 patients and used a chronometer to accurately record the time spent in each activity mapped. Costs generated through TDABC were combined with the cost of supplies, equipment, medications, and other direct and indirect operational activities to obtain the total cost. The cost of drugs, durable medical equipment, and supplies was obtained using the traditional costing method for the TDABC group as well. The results of both costing methods were then compared by 2 independent financial analysts. Results: The average standardized hospital cost of the 25 primary rTSAs included in the study was estimated to be $21,579 using traditional costing and $16,547 using TDABC. Medical devices represented the largest cost using both methods (39% of the total cost for traditional costing and 51% for TDABC). Traditional costing overestimated personnel cost and fixed direct costs compared to TDABC. On average, surgeons spent an average of 47 minutes to perform the critical portion of the rTSA procedure. The average per minute salary cost for all personnel categories was $24. Conclusion: In a high-volume institution, there was an average $5,000 difference in estimated costs using traditional costing vs. TDABC. This methodology and results represent a benchmark that can be used to understand the potential added cost of digital enabling technology, and particularly robotic-assisted rTSA, as widespread adoption increases over time.

Source: Journal of Shoulder and Elbow Arthroplasty

DOI: 10.1016/j.jsea.2026.100087