Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH.
J Arthroplasty. 2021 Dec;36(12):3831-3838. doi: 10.1016/j.arth.2021.08.023. Epub 2021 Aug 30.
Work relative value units (wRVUs) measure a surgeon's time and intensity required to perform the pre-service, intra-service, and post-service work of a surgical procedure and are commonly used to compare a physician's work between different procedures. Previous literature across multiple specialties report that longer, often revision, operations are undervalued when compared to primary procedures. Our study aims to analyze the differences in intra-operative time, and its corresponding wRVU/h between the Medicare benchmarks and real-world time-stamped data for total joint arthroplasty procedures.
Thirteen primary and revision hip and knee arthroplasty procedures were identified, and intra-operative times were collected using the National Surgical Quality Improvement Program databases from 2014 to 2019. The Relative Value Scale Update Committee's (RUC) estimated median intra-operative times for each procedure was compared to the calculated median intra-operative times from National Surgical Quality Improvement Program, as were their corresponding wRVU/h. Procedures were additionally stratified by "long" (>110 minutes) and "short" (≤110 minutes) intra-operative times.
The RUC over-estimated intra-operative time by 35.24% on average and this overestimation was more profound in longer operations than shorter operations (47.75% vs 15.22%, P = .011). The RUC intensity per unit time values (wRVU/h) between "long" and "short" procedures were significantly different (P < .001) and showed the undervaluation of intensity for the longer procedures by an average of 3.47 wRVU/h.
Our study provides further evidence that physician work is undervalued in revision total hip and knee surgeries.
工作相对价值单位（wRVU）衡量外科医生执行手术前、手术中和手术后工作所需的时间和强度，常用于比较不同手术程序中医生的工作。多项专业的文献报告称，与初次手术相比，时间较长、通常为修正手术的操作被低估了。我们的研究旨在分析 Medicare 基准与全关节置换术实际时间标记数据之间手术过程中时间及其对应的 wRVU/h 的差异。
确定了 13 例初次和修正髋关节和膝关节置换术，使用国家外科质量改进计划数据库从 2014 年到 2019 年收集手术中的时间。将相对价值量表更新委员会（RUC）对每个程序的估计中位数手术时间与国家外科质量改进计划计算的中位数手术时间进行比较，以及它们对应的 wRVU/h。程序还按“长”（>110 分钟）和“短”（≤110 分钟）手术时间进行分层。
RUC 平均高估手术时间 35.24%，且在较长手术中高估程度大于较短手术（47.75%比 15.22%，P =.011）。“长”和“短”手术之间的 RUC 强度单位时间值（wRVU/h）差异显著（P <.001），表明较长手术的强度被低估了，平均为 3.47 wRVU/h。
我们的研究进一步证明，修正全髋关节和膝关节手术中医生的工作被低估了。
