Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
J Arthroplasty. 2018 Feb;33(2):340-344. doi: 10.1016/j.arth.2017.09.019. Epub 2017 Sep 19.
Relative value units (RVUs) are used to evaluate the effort required for providing a service to patients in order to determine compensation. Thus, more complicated cases, like revision arthroplasty cases, should yield a greater compensation. However, there are limited data comparing RVUs to the time required to complete the service. Therefore, the purpose of this study is to compare the (1) mean RVUs, (2) mean operative times, and (3) mean RVU/minute between primary and revision total hip arthroplasty (THA) and (4) perform an individualized idealized surgeon annual cost difference analysis.
A total of 103,702 patients who underwent primary (current procedural terminology code 27130) and 7273 patients who underwent revision THA (current procedural terminology code 27134) were identified using the National Surgical Quality Improvement Program database. Mean RVUs, operative times (minutes), and RVU/minute were calculated and compared using Student t-test. Dollar amount per minute, per case, per day, and year was calculated to find an individualized idealized surgeon annual cost difference.
The mean RVU was 21.24 ± 0.53 (range, 20.72-21.79) for primary and 30.27 ± 0.03 (range, 30.13-30.28) for revision THA (P < .001). The mean operative time for primary THA was 94 ± 38 minutes (range, 30-480 minutes) and 152 ± 75 minutes (range, 30-475 minutes) for revision THA (P < .001). The mean RVU/minute was 0.260 ± 0.10 (range, 0.04-0.73) for primary and 0.249 ± 0.12 (range, 0.06-1.0) for revision cases (P < .001). The dollar amounts calculated for primary vs revision THA were as follows: per minute ($9.33 vs $8.93), per case ($877.12 vs $1358.32), per day ($6139.84 vs $5433.26), and a projected $113,052.28 annual cost difference for an individual surgeon.
Maximizing the RVU/minute provides the greatest "hourly rate." The RVU/minute for primary (0.260) being significantly greater than revision THA (0.249) and an annualized $113,052.28 cost difference reveal that although revision THAs are more complex cases requiring longer operative time, greater technical skill, and aftercare, compensation per time is not greater.
相对价值单位（RVU）用于评估为患者提供服务所需的工作量，以确定补偿。因此，更复杂的病例，如翻修关节置换术病例，应该获得更高的补偿。然而，比较 RVU 与完成服务所需时间的数据有限。因此，本研究的目的是比较（1）原发性和（2）翻修性全髋关节置换术（THA）的（a）平均 RVU、（b）平均手术时间和（c）平均 RVU/分钟，并（d）进行个体化理想化医生年度成本差异分析。
使用国家手术质量改进计划数据库，确定了 103702 例原发性（当前程序术语代码 27130）和 7273 例翻修性 THA（当前程序术语代码 27134）患者。使用学生 t 检验计算和比较平均 RVU、手术时间（分钟）和 RVU/分钟。每分钟、每例、每天和每年的美元金额被计算出来，以发现个体化理想化医生年度成本差异。
原发性 THA 的平均 RVU 为 21.24±0.53（范围，20.72-21.79），翻修性 THA 的平均 RVU 为 30.27±0.03（范围，30.13-30.28）（P<0.001）。原发性 THA 的平均手术时间为 94±38 分钟（范围，30-480 分钟），翻修性 THA 的平均手术时间为 152±75 分钟（范围，30-475 分钟）（P<0.001）。原发性和翻修性病例的平均 RVU/分钟分别为 0.260±0.10（范围，0.04-0.73）和 0.249±0.12（范围，0.06-1.0）（P<0.001）。原发性与翻修性 THA 的计算美元金额如下：每分钟（9.33 美元与 8.93 美元）、每例（877.12 美元与 1358.32 美元）、每天（6139.84 美元与 5433.26 美元）和个体医生的年度成本差异预计为 113052.28 美元。
最大限度地提高 RVU/分钟可提供最高“时薪”。原发性（0.260）的 RVU/分钟明显大于翻修性 THA（0.249），且每年的 113052.28 美元的成本差异表明，尽管翻修性 THA 是更复杂的病例，需要更长的手术时间、更高的技术技能和后续护理，但补偿时间并不更长。
