复杂皮肤闭合术对学术性外科黑色素瘤实践的相对价值单位影响。

Department of Surgery, Division of General Surgery and Trauma, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Am J Surg. 2012 Sep;204(3):327-31. doi: 10.1016/j.amjsurg.2011.10.014.

BACKGROUND

Melanoma excisions frequently are associated with significant soft-tissue defects, creating the need for complex closures. These closures could be performed by either surgical oncologists or plastic surgeons. We sought to quantify the relative value units (RVUs) and describe the practice patterns of 2 academic surgical subspecialties after a melanoma excision.

METHODS

After institutional review board approval, a retrospective data analysis of a billing database was conducted on all melanoma patients undergoing an excision and closure by surgical oncology and plastic surgery departments in 2007. Data were obtained using billing records for Current Procedural Terminology diagnosis codes. RVUs were used to quantify the value added to each practice from these closures. The surgical oncologist and patient decided if a plastic surgeon was needed.

RESULTS

A total of 270 closures were performed, 53 (19.9%) primary and 217 (80.1%) complex. The surgical oncologists performed most complex closures (188; 86.6%), and the plastic surgeons performed the remainder (29; 13.4%), generating a total of 1,921 RVUs (1,630 by the surgical oncologists and 291 by the plastic surgeons). For analysis, complex closures were divided among 4 anatomic sites: trunk, upper extremity, lower extremity, and head and neck. Most closures by the surgical oncologists were adjacent tissue rearrangements (155; 82%) and the remainder were skin grafts (33; 18%). Closures by the plastic surgeons were more likely to be a full-thickness skin graft (P < .0027) in the head and neck region (P < .0001), with a higher associated median RVU/case (10.15 compared with 8.44 for the surgical oncologists; P < .0002).

CONCLUSIONS

At our institution, the majority of melanoma closures were performed by surgical oncologists. However, plastic surgery often was involved in more complex closures in the head and neck. This data set quantifies the RVUs added and describes the types of closures performed in an academic melanoma practice.

背景

黑色素瘤切除术常伴有明显的软组织缺损，需要进行复杂的闭合。这些闭合可以由外科肿瘤学家或整形外科医生进行。我们试图量化 2 个学术外科亚专业在黑色素瘤切除术后的相对价值单位 (RVU) 和描述其手术方式。

方法

在机构审查委员会批准后，对 2007 年接受外科肿瘤学和整形外科切除和闭合的所有黑色素瘤患者的计费数据库进行回顾性数据分析。数据是通过使用当前程序术语诊断代码的计费记录获得的。RVU 用于量化这些闭合为每个实践增加的价值。外科肿瘤学家和患者决定是否需要整形外科医生。

结果

共进行了 270 次闭合，53 次（19.9%）为原发性，217 次（80.1%）为复杂性。外科肿瘤学家进行了大多数复杂的闭合（188 次；86.6%），而整形外科医生进行了其余的闭合（29 次；13.4%），共产生了 1921 个 RVU（外科肿瘤学家 1630 个，整形外科医生 291 个）。为了分析，将复杂的闭合分为 4 个解剖部位：躯干、上肢、下肢和头颈部。外科肿瘤学家进行的大多数闭合是相邻组织的重新排列（155 次；82%），其余是皮瓣（33 次；18%）。整形外科医生进行的闭合更有可能是头颈部的全厚皮瓣（P <.0027），并且相关的中位数 RVU/例更高（10.15 比外科肿瘤学家的 8.44；P <.0002）。