Procedures with Longer Intra-Operative Times Undervalue Surgeon Work in Total Joint Arthroplasty: A Large, Nationwide Database Study

Abstract Background Work relative-value-units (wRVU) 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/hour between the Medicare benchmarks and real-world time-stamped data for total joint arthroplasty procedures. Methods Thirteen primary and revision hip and knee arthroplasty procedures were identified, and intra-operative times were collected using the National Surgical Quality Improvement Program (NSQIP) databases from 2014-2019. The Relative Value Update Committee’s (RUC) estimated median intra-operative times for each procedure was compared to the calculated median intra-operative times from NSQIP, as were their corresponding wRVU/hour. Procedures were additionally stratified by “long” (>110 min) and “short” (≤ 110 min) intra-operative times. Results 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=0.011). The RUC intensity per unit time values (wRVU/hr) between “long” and “short” procedures were significantly different (p Conclusion Our study provides further evidence that physician work is undervalued in revision total hip and knee surgeries.