From the Institute for Reconstructive Surgery.
Department of Orthopedic Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX.
Ann Plast Surg. 2022 Feb 1;88(2):208-211. doi: 10.1097/SAP.0000000000002900.
Work relative value units (wRVUs) are part of Resource Based Relative Value Scale system. It is expected that a more difficult and time-consuming procedure would yield higher wRVUs. Brachial plexus nerve decompression surgery is a more time-consuming procedure compared with carpal and cubital tunnel procedures. The aim of this study was to analyze physician reimbursement in upper limb decompression procedures by comparing mean operative times, wRVUs per minute, and dollars per minute.
A retrospective cohort study was conducted from June 2016 to June 2019, including all patients who underwent carpal tunnel, cubital tunnel, and brachial plexus release procedures. Operating time was collected, and calculations of mean operative time, wRVUs per minute, and dollars per minute were performed and compared between groups.
A total of 209 cases were included. Carpal tunnel accounted for 75.1% of the cases, followed by cubital tunnel and brachial plexus releases. Brachial plexus release had the highest median operative time (147 minutes), followed by cubital tunnel (57 minutes) and carpal tunnel release (16 minutes, P < 0.0001). Carpal tunnel release procedures had a significantly higher wRVUs per minute (0.310) when compared with cubital tunnel and brachial pleaxus release procedures, 0.127 and 0.077, respectively (P < 0.0001). Same was true for dollars per minute; carpal tunnel procedures yielded significantly more compensation than cubital tunnel and thoracic outlet procedures (P < 0.0001).
More complex and time-consuming procedures yielded a lower reimbursement for physicians. The current work relative unit system does not account adequately for the time spent in each procedure.
工作相对价值单位（wRVUs）是资源基础相对价值量表系统的一部分。预计更困难和耗时的程序将产生更高的 wRVUs。与腕管和肘管手术相比，臂丛神经减压手术是一个更耗时的过程。本研究旨在通过比较平均手术时间、每分钟 wRVUs 和每分钟美元来分析上肢减压手术中医生的报酬。
这是一项从 2016 年 6 月至 2019 年 6 月进行的回顾性队列研究，包括所有接受腕管、肘管和臂丛松解术的患者。收集手术时间，并对各组之间的平均手术时间、每分钟 wRVUs 和每分钟美元进行计算和比较。
共纳入 209 例患者。腕管占 75.1%，其次是肘管和臂丛松解术。臂丛神经松解术的中位手术时间最长（147 分钟），其次是肘管（57 分钟）和腕管松解术（16 分钟，P < 0.0001）。与肘管和臂丛松解术相比，腕管松解术每分钟 wRVUs 显著更高（0.310），分别为 0.127 和 0.077（P < 0.0001）。每分钟美元也是如此；腕管手术产生的补偿明显高于肘管和胸廓出口手术（P < 0.0001）。
更复杂和耗时的程序为医生带来的报酬更低。目前的工作相对单位系统没有充分考虑到每个程序所花费的时间。
