Department of Urology, University of North Carolina at Chapel Hill, NC.
Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, NC.
Surgery. 2020 Sep;168(3):365-370. doi: 10.1016/j.surg.2020.04.018. Epub 2020 Jun 15.
Although relative value units are used to measure physician productivity, research has demonstrated incongruencies between relative value units and actual surgeon work effort. We sought to determine whether this variation extends across surgical specialties.
A retrospective review of surgical cases was conducted using the 2017 American College of Surgeons National Surgical Quality Improvement Program database. For each case, we identified the primary Current Procedural Terminology, surgical specialty, total relative value units, and 5 alternative measures of work effort. We then examined the correlation between a Current Procedural Terminology's mean total relative value unit and work effort. Finally, we constructed a multivariable linear regression model to evaluate the association between surgical specialty and the expected mean total relative value unit adjusting for work effort and patient characteristics.
A total of 876,515 cases met the inclusion criteria. Overall, median operative time correlated well with mean total relative value unit (R = 0.85), though it was lowest for cardiac surgery (R = 0.51) and highest for otolaryngology (R = 0.97). Neurosurgery had the greatest increase in mean total relative value unit per hour of operative time (12.9/h). Mean total relative value unit correlated modestly with length of stay (R = 0.58) and serious adverse events (R = 0.61) and weakly with readmission (R = 0.42) and mortality (R = 0.29). When holding these metrics constant, the multivariable model showed mean total relative value units differed according to surgical specialty alone. Compared with general surgery, neurosurgery and cardiac surgery earned 3.41 to 3.61 additional mean total relative value units (P < .05), while orthopedics, otolaryngology, thoracic, urology, and vascular surgery received fewer mean total relative value units (-1.84 to -4.43, P < .05).
Surgeon productivity is increasingly measured using relative value units. While mean total relative value units correlate well with operative time, they may not reflect other aspects of work effort. Differences in mean total relative value units by surgical specialty demonstrate potential inequities in the determination of physician productivity.
尽管相对价值单位被用于衡量医生的生产力，但研究表明相对价值单位与实际外科医生的工作努力之间存在不一致性。我们试图确定这种差异是否在外科专业之间存在。
使用 2017 年美国外科医师学院国家外科质量改进计划数据库对手术病例进行回顾性研究。对于每个病例，我们确定了主要的当前程序术语、外科专业、总相对价值单位和 5 种替代工作努力措施。然后，我们检查了当前程序术语的平均总相对价值单位与工作努力之间的相关性。最后，我们构建了一个多变量线性回归模型，以评估在调整工作努力和患者特征后，外科专业与预期平均总相对价值单位之间的关联。
共有 876,515 例符合纳入标准。总体而言，手术时间中位数与平均总相对价值单位相关性良好（R=0.85），但心脏手术最低（R=0.51），耳鼻喉科最高（R=0.97）。神经外科每小时手术时间的平均总相对价值单位增加最多（12.9/h）。平均总相对价值单位与住院时间（R=0.58）和严重不良事件（R=0.61）中度相关，与再入院（R=0.42）和死亡率（R=0.29）弱相关。当保持这些指标不变时，多变量模型显示平均总相对价值单位仅根据外科专业而有所不同。与普通外科相比，神经外科和心脏外科获得了 3.41 至 3.61 个额外的平均总相对价值单位（P<.05），而骨科、耳鼻喉科、胸外科、泌尿科和血管外科则获得了较少的平均总相对价值单位（-1.84 至-4.43，P<.05）。
外科医生的生产力越来越多地使用相对价值单位来衡量。虽然平均总相对价值单位与手术时间相关性良好，但它们可能无法反映工作努力的其他方面。外科专业之间平均总相对价值单位的差异表明，在确定医生生产力方面存在潜在的不公平现象。
