Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, Ohio.
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
J Knee Surg. 2021 Jul;34(8):834-840. doi: 10.1055/s-0039-3400949. Epub 2019 Nov 28.
Recently, the Centers for Medicare & Medicaid Services announced its decision to review "potentially misvalued" Current Procedural Terminology (CPT) codes, including those for primary total knee arthroplasty (TKA). CPT 27447 is being reevaluated to determine contemporary relative value units for work value, with operative time considered a primary factor in this revaluation. Despite broader indications for TKA, including extension of the procedure to more complex patient populations, it is unknown whether operative times may remain stable in the future. Therefore, the purpose of this study was to specifically evaluate future trends in TKA operative times across a large sample from a national database. The American College of Surgeons National Surgical Quality Improvement Project database was queried from January 1, 2008 to December 31, 2017 to identify 286,816 TKAs using the CPT code 27447. Our final analysis included 140,890 TKAs. Autoregressive integrated moving average forecasting models were built to predict 2- and 10-year operative times. While operative times were significantly different between American Society of Anesthesiologists (ASA) classes 1 and 2 ( = 0.035), there were not enough patients in ASA class 1 to perform rigorous inference. Additionally, operative times were not significantly different between ASA classes 3 and the combined ASA classes 4 and 5 cohort ( = 0.95). Therefore, we were only able to perform forecasts for ASA classes 2 and 3. Operative time was found to be nonstationary for both ASA class 2 ( = 0.08269) and class 3 ( = 0.2385). As a whole, the projection models indicated that operative time will remain within 2 minutes of the present operative time, up to the year 2027. Our projections indicate that operative times will remain stable over the next decade. This suggests that there is a lack of evidence for reducing the valuation of CPT code 27477 based on intraservice time for TKA. Further study should examine operative time trends in the setting of evolving alternative payment models, increasing patient complexity, and governmental restrictions.
最近，医疗保险和医疗补助服务中心宣布决定审查“可能被高估”的当前程序术语 (CPT) 代码，包括初次全膝关节置换术 (TKA) 的代码。CPT 27447 正在重新评估，以确定工作价值的当代相对价值单位，其中手术时间被认为是这种重新评估的主要因素。尽管 TKA 的适应证更广泛，包括将手术扩展到更复杂的患者人群，但尚不清楚未来手术时间是否可能保持稳定。因此，本研究的目的是专门从全国数据库的大量样本中评估 TKA 手术时间的未来趋势。从 2008 年 1 月 1 日至 2017 年 12 月 31 日，美国外科医师学院国家手术质量改进项目数据库被查询，以使用 CPT 代码 27447 确定 286,816 例 TKA。我们的最终分析包括 140,890 例 TKA。自回归综合移动平均预测模型用于预测 2 年和 10 年的手术时间。虽然 ASA 分级 1 和 2 之间的手术时间有显著差异（=0.035），但 ASA 分级 1 中的患者数量不足以进行严格推断。此外，ASA 分级 3 和 ASA 分级 4 和 5 合并组之间的手术时间没有显著差异（=0.95）。因此，我们只能对 ASA 分级 2 和 3 进行预测。ASA 分级 2（=0.08269）和分级 3（=0.2385）的手术时间均被发现是非平稳的。总体而言，预测模型表明，在 2027 年之前，手术时间将保持在当前手术时间的 2 分钟以内。我们的预测表明，在未来十年内，手术时间将保持稳定。这表明，没有证据表明基于 TKA 的服务内时间降低 CPT 代码 27477 的估值。进一步的研究应该检查在不断发展的替代支付模式、患者复杂性增加和政府限制的情况下手术时间趋势。
