Nguyen Khang T, Gart Michael S, Smetona John T, Aggarwal Apas, Bilimoria Karl Y, Kim John Y S
Northwestern University Feinberg School of Medicine.
Eplasty. 2012;12:e60. Epub 2012 Dec 27.
Relative value units (RVUs) were developed as a quantifier of requisite training, knowledge, and technical expertise for performing various procedures. In select procedures, increasing RVUs have been shown to substitute well for increasing surgical complexity and have been linked to greater risk of complications. The relationship of RVU to outcomes has yet to be examined in the plastic surgery population.
This study analyzed nearly 15,000 patients from a standardized, multicenter database to better define the link between RVUs and outcomes in this surgical population. The American College of Surgeons' National Surgical Quality Improvement Program was retrospectively reviewed from 2006 to 2010.
A total of 14,936 patients undergoing primary procedures of plastic surgery were identified. Independent risk factors for complications were analyzed using multivariable logistic regression. A unit increase in RVUs was associated with a 1.7% increase in the odds of overall complications and 1.0% increase in the odds of surgical site complications but did not predict mortality or reoperation. A unit increase in RVUs was also associated with a prolongation of operative time by 0.41 minutes, but RVUs only accounted for 15.6% of variability in operative times.
In the plastic surgery population, increasing RVUs correlates with increased risks of overall complications and surgical site complications. While increasing RVUs may independently prolong operative times, they only accounted for 15.6% of observed variance, indicating that other factors are clearly involved. These findings must be weighed against the benefits of performing more complex surgeries, including time and cost savings, and considered in each patient's risk-benefit analysis.
相对价值单位（RVUs）被开发出来作为执行各种手术所需培训、知识和技术专长的量化指标。在某些手术中，已表明增加RVUs能很好地替代增加的手术复杂性，并与更高的并发症风险相关联。RVU与手术结果之间的关系尚未在整形外科人群中进行研究。
本研究分析了来自标准化多中心数据库的近15000名患者，以更好地确定该手术人群中RVUs与手术结果之间的联系。对美国外科医师学会国家外科质量改进计划2006年至2010年的数据进行了回顾性分析。
共确定了14936例接受整形外科初次手术的患者。使用多变量逻辑回归分析并发症的独立危险因素。RVUs每增加一个单位，总体并发症发生几率增加1.7%，手术部位并发症发生几率增加1.0%，但不能预测死亡率或再次手术情况。RVUs每增加一个单位，手术时间也会延长0.41分钟，但RVUs仅占手术时间变异性的15.6%。
在整形外科人群中，增加RVUs与总体并发症和手术部位并发症风险增加相关。虽然增加RVUs可能会独立延长手术时间，但它们仅占观察到的变异性的15.6%，表明显然还有其他因素参与其中。这些发现必须与进行更复杂手术的益处（包括节省时间和成本）相权衡，并在每个患者的风险效益分析中加以考虑。
