Asthana Shravan, Bajaj Pranav, Staub Jacob, Workman Connor, Khazanchi Rushmin, Reyes Samuel, Patel Alpesh A, Hsu Wellington K, Divi Srikanth N
Department of Orthopedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Clin Spine Surg. 2025 Apr 1;38(3):E141-E144. doi: 10.1097/BSD.0000000000001684. Epub 2024 Oct 31.
Retrospective database study.
This study aims to quantify and compare mean work RVUs (wRVUs), mean operative time (OpTime), and wRVUs/min in single- and multilevel anterior and posterior cervical spine fusions performed between 2011 and 2020.
Prior research has demonstrated inconsistencies in technical skill, operative time, and surgical difficulty with reimbursement in various orthopedic subspecialties. Although trends investigating physician effort and reimbursement have been investigated in lumbar spine surgery, less research has examined these relationships with respect to cervical spine procedures.
The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried for Current Procedural Terminology (CPT) codes reflecting anterior cervical discectomy and fusion (ACDF), posterior cervical decompression and fusion (PCDF), and the number of levels involved. The cohort was stratified into 10 groups: single-level, 2-level, 3-level, 4-level, 5+ level anterior or posterior cervical fusions. Mean operative times, mean wRVUs, and wRVU/min were calculated and compared by Student t test.
A total of 100,997 patients met inclusion criteria in this study, of which 79,141 (78.36%) underwent ACDF, whereas 21,836 (21.62%) underwent PCDF. One- and 2-level fusions were most common in both ACDF and PCDF. In 1-, 3-, 4-, and 5+ level fusion, the anterior approach demonstrated significantly lower mean wRVU ( P <0.001). In 1-, 2-, and 3-level fusions, the anterior approach had significantly lower operation times ( P <0.001). The anterior approach demonstrated significantly higher wRVU/min in 1- and 2- levels ( P <0.001) but lower wRVU/min in 3- and 4-level fusions ( P <0.001).
Clear discrepancies exist between surgical approach and levels of fusion in cervical spine procedures incongruous with markers of surgical difficulty, physician effort, or expertise required. These specific results suggest that the complexity of multi-level anterior cervical fusions are not effectively accounted for by existing RVU measures.
回顾性数据库研究。
本研究旨在量化并比较2011年至2020年间进行的单节段和多节段颈椎前路及后路融合手术的平均工作相对价值单位（wRVUs）、平均手术时间（OpTime）以及每分钟wRVUs。
先前的研究表明，在各个骨科亚专业中，技术水平、手术时间和手术难度与报销费用之间存在不一致性。尽管在腰椎手术中已经对医生的工作量和报销费用的趋势进行了研究，但关于颈椎手术的这些关系的研究较少。
查询美国外科医师学会国家外科质量改进计划（NSQIP），获取反映颈椎前路椎间盘切除融合术（ACDF）、颈椎后路减压融合术（PCDF）以及所涉及节段数目的现行手术操作术语（CPT）编码。该队列被分为10组：单节段、2节段、3节段、4节段、5节段及以上的颈椎前路或后路融合术。通过学生t检验计算并比较平均手术时间、平均wRVUs和每分钟wRVUs。
本研究共有100,997例患者符合纳入标准，其中79,141例（78.36%）接受了ACDF，而21,836例（21.6%）接受了PCDF。单节段和2节段融合术在ACDF和PCDF中最为常见。在1节段、3节段、4节段和5节段及以上融合术中，前路手术的平均wRVU显著较低（P<0.001）。在1节段、2节段和3节段融合术中，前路手术的手术时间显著较短（P<0.001）。前路手术在1节段和2节段时每分钟wRVU显著较高（P<0.001），但在3节段和4节段融合术中每分钟wRVU较低（P<0.001）。
颈椎手术的手术方式与融合节段之间存在明显差异，这与手术难度、医生工作量或所需专业知识的指标不一致。这些具体结果表明，现有的相对价值单位（RVU）测量方法未能有效考虑多节段颈椎前路融合术的复杂性。
