From the Division of Plastic Surgery, University of California San Diego Health.
Drexel University College of Medicine.
Plast Reconstr Surg. 2023 Nov 1;152(5):1129-1136. doi: 10.1097/PRS.0000000000010306. Epub 2023 Feb 15.
The relationship between procedural complexity and relative value units (RVUs) awarded has been studied within some specialties, but it has not yet been compared across different surgical disciplines. This study aims to analyze the association of RVUs with operative time as a surrogate for complexity across surgical specialties, with a focus on plastic surgery.
A retrospective review of surgical cases was conducted with the 2019 National Surgical Quality Improvement Program database. The top 10 most performed procedures per surgical specialty were identified based on case volume. Only cases with a single CPT code were analyzed. A subanalysis of plastic surgery procedures was also conducted to include unilateral and bilateral procedures with a frequency greater than 20.
Overall, operative time correlated strongly with work RVUs (R = 0.86). Orthopedic surgery had one of the shortest average operative times with the greatest work RVUs per hour, in contrast to plastic surgery, with the greatest average operative time and one of the lowest work RVUs per hour. Of the plastic surgery procedures analyzed, only five were valued on par with the average calculated from all other specialties. The most poorly rewarded procedure for time spent is unilateral free flap breast reconstruction.
Of all the surgical specialties, plastic surgery has the lowest RVUs per hour and the highest average operative time, leading to severe potential undervaluation compared with other specialties. This study suggests that further reevaluation of the current RVU system is needed to account for complexity more equitably as well as encourage value-based care.
程序性复杂性与相对价值单位（RVUs）之间的关系已在某些专业领域进行了研究，但尚未在不同的外科专业之间进行比较。本研究旨在分析 RVUs 与手术时间之间的关联，以作为衡量手术复杂性的替代指标，重点关注整形外科学。
对 2019 年国家手术质量改进计划数据库中的外科手术病例进行回顾性分析。根据手术量确定每个外科专业排名前十的最常进行的手术。仅分析仅包含单一 CPT 代码的病例。还对整形手术程序进行了亚分析，纳入了单侧和双侧手术频率大于 20 的病例。
总体而言，手术时间与工作 RVUs 高度相关（R = 0.86）。与整形外科相比，骨科手术的平均手术时间最短，每小时的工作 RVUs 最高，整形外科的平均手术时间最长，每小时的工作 RVUs 最低。在所分析的整形手术中，只有 5 种手术的价值与所有其他专业计算得出的平均值相当。从花费的时间来看，最不被重视的手术是单侧游离皮瓣乳房重建术。
在所有外科专业中，整形外科每小时的 RVUs 最低，平均手术时间最长，与其他专业相比，存在严重的潜在低估风险。本研究表明，需要进一步重新评估当前的 RVU 系统，以更公平地考虑复杂性，并鼓励基于价值的护理。
