The Relationship between Relative Value Units and Operation Time in Plastic and Reconstructive Surgery

PURPOSE: Work relative value units (wRVUs) are intricately linked to patient care reimbursements and physician compensation. For this reason, wRVUs should be assigned to procedures taking into account the time requirement, complexity, and skillset of the physician providing care. This analysis of a national database analyzes the association among operation time, postoperative complication rate, and assigned wRVUs in plastic and reconstructive surgery. METHODS: The 2015–2018 National Surgical Quality Improvement Program was queried for all cases with assigned wRVUs and a positive operation time being completed by plastic surgery as the primary service. Cases with concurrent procedures being done were excluded. Only the top 50 CPT codes were included in the final analysis. Surgical complexity was based on postoperative complications, including unplanned readmission or return to the operating room, wound complications, and medical complications within 30 days of surgery. The median operation time, assigned wRVUs, and rate of postoperative complications were captured for each procedure. Linear regressions and correlations were computed between these variables to assess their relative relationships. Expected wRVUs were calculated from median operation time following linear regression analysis. Procedures with the highest deviation from expected were identified. RESULTS: A total of 31,156 cases were included in this analysis. The most commonly performed procedures were reduction mammaplasty, panniculectomy, breast augmentation, and revision of a reconstructed breast. Among all the cases, the median assigned wRVUs was 15.9, operation time was 97 minutes, and wRVUs per hour was 9.8. There were wide ranges in assigned wRVUs per hour (2.2–16.2 wRVU/h) and complication rate (0.5%–29.7%). There was a strong positive linear correlation between assigned wRVUs and median operation time (R2 = 0.78, P < 0.001), with each additional procedural hour being associated with an increase of 5.3 wRVUs. The procedures with the largest positive deviation from expected were breast reconstruction with other technique (CPT 19366) and tissue expander placement in breast reconstruction (CPT 19357), at 199.2% and 167.4% of expected, respectively. On the other hand, those with the largest negative deviation from expected were excisional debridement of the subcutaneous tissue (CPT 11042) and excisional debridement of the muscle and/or fascia (CPT 11043), at 16.0% and 45.6% of expected, respectively. There were minimal positive associations between median operation time and complication rate (R2 = 0.08, P = 0.047) as well as assigned wRVUs and complication rate (R2 = 0.10, P = 0.025). There was no correlation between complication rate and wRVUs per hour. CONCLUSIONS: This analysis suggests that although there is a wide range of assigned wRVUs per hour, assigned wRVUs and median operation time are highly correlated in plastic and reconstructive surgery.