OBJECTIVES: To map the clinical pathway and calculate the true cost of performing TKA surgery from the hospital perspective.

METHODS: Inpatient pathways from pre-operative admission to discharge were prospectively mapped for 14 TKA cases at a tertiary medical center in Japan. Study patients (aged >>

RESULTS: The average LOS for TKA was 19.7d spread across the pre-op (2.1d), surgery (1.0d), acute ward (8.7d), and sub-acute ward (7.9d) periods. Total surgery time was 117 min from incision to closure. Selected personnel capacity rates were as follows: orthopedic surgeons (143.1 ¥/min), nurses (51.5 ¥/min), physical therapists (53.4 ¥/min), clinical engineers (55.7 ¥/min), medical social workers (34.2 ¥/min), and health information specialists (52.4 ¥/min). The total cost to perform TKA was ¥1,119,373 per case. Of this, labor, direct materials (both reimbursed and non-reimbursed), and indirect facility overhead contributed 25.5%, 44.6%, and 27.7%, respectively.

CONCLUSIONS: The use of TDABC provides granular, realistic insights into care processes at the service line level, and may inform strategic decision-making, reduce operational inefficiencies, and accurately define costs, and thereby value, in clinical care.