病例总工作相对价值单位、手术应激与患者脆弱性的相关性：回顾性队列研究。
The Correlation Between Case Total Work Relative Value Unit, Operative Stress, and Patient Frailty: Retrospective Cohort Study.
机构信息
Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
出版信息
Ann Surg. 2021 Oct 1;274(4):637-645. doi: 10.1097/SLA.0000000000005068.
OBJECTIVE
Assess the relationships between case total work relative value units (wRVU), patient frailty, and the physiologic stress of surgical interventions.
SUMMARY OF BACKGROUND DATA
Surgeon reimbursement is frequently apportioned by wRVU. These subjective, procedure-specific valuations generated by physician survey estimate the intensity and time for typical patient care services. We hypothesized wRVU would not adequately account for patient-specific factors, such as frailty, that modify the required physician work, regardless of procedural complexity.
METHODS
Using National and Veterans Affairs Surgical Quality Improvement Programs (2015-2018), we evaluated the correlation between case total wRVU, patient frailty (risk analysis index) and physiologic surgical stress (operative stress score).
RESULTS
Of 4,111,371 (86%) cases, the correlation between total wRVU and operative stress was moderate [ρs = 0.587 (95% confidence interval, 0.586-0.587)], but negligible with frailty ρ = 0.177 (95% confidence interval, 0.176-0.178)]. Very high operative stress procedures [n = 34,047 (1%)] generated a mean total wRVU of 55.1 (standard deviation, 12.9), comprising 7%, 2%, and 1% of thoracic, vascular, and general surgical cases, respectively. Very frail patients [n = 152,535 (4%)] accounted for 9% of thoracic, 9% of vascular, 4% of general, 5% of urologic, and 4% of neurologic surgical cases, generating 21.0 (standard deviation, 12.4) mean total wRVU. Some nonfrail patients undergoing low operative stress procedures [n = 60,128 (2%)] nonetheless generated the highest quintile wRVU; these comprised >15% of plastic, gynecologic, and urologic surgical cases.
CONCLUSIONS
Surgeon reimbursement correlates with operative stress but not patient frailty. The total wRVU does not adequately reflect patient-specific factors that increase the physician workload required to render optimal care to complex patients.
目的
评估病例总工作相对价值单位（wRVU）、患者脆弱性与手术干预的生理应激之间的关系。
背景资料总结
外科医生的报酬通常按 wRVU 分配。这些由医生调查产生的主观、特定于程序的评估值估计了典型患者护理服务的强度和时间。我们假设 wRVU 不会充分考虑患者特定因素，例如脆弱性，这些因素会改变所需的医生工作量，而不论手术复杂性如何。
方法
使用国家和退伍军人事务部手术质量改进计划（2015-2018 年），我们评估了病例总 wRVU、患者脆弱性（风险分析指数）和生理手术应激（手术应激评分）之间的相关性。
结果
在 4111371 例（86%）病例中，总 wRVU 与手术应激之间的相关性为中度[ρs=0.587（95%置信区间，0.586-0.587)]，而与脆弱性的相关性微不足道，ρ=0.177（95%置信区间，0.176-0.178)]。非常高的手术应激程序[n=34047（1%）]产生的平均总 wRVU 为 55.1（标准差，12.9），分别占胸外科、血管外科和普通外科病例的 7%、2%和 1%。非常脆弱的患者[n=152535（4%）]占胸外科、血管外科、普通外科、泌尿外科和神经外科病例的 9%、9%、4%、5%和 4%，产生 21.0（标准差，12.4）的平均总 wRVU。一些接受低手术应激程序的非脆弱患者[n=60128（2%）]尽管如此，仍产生了最高五分位数的 wRVU；这些占整形外科、妇科和泌尿科手术病例的>15%。
结论
外科医生的报酬与手术应激相关，但与患者脆弱性无关。总 wRVU 不能充分反映增加为复杂患者提供最佳护理所需的医生工作量的患者特定因素。
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