单层和多层颈椎融合术的前路或后路 RVU 补偿比较。

IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY
Shravan Asthana, Pranav Bajaj, Jacob Staub, Connor Workman, Rushmin Khazanchi, Samuel Reyes, Alpesh A Patel, Wellington K Hsu, Srikanth N Divi
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引用次数: 0

摘要

研究设计回顾性数据库研究:本研究旨在量化和比较 2011 年至 2020 年间实施的单层和多层颈椎前后路融合术的平均工作 RVUs(wRVUs)、平均手术时间(OpTime)和 wRVUs/min:先前的研究表明,不同骨科亚专科的技术水平、手术时间和手术难度与报销不一致。虽然已对腰椎手术中医生的努力和报销趋势进行了调查,但较少研究颈椎手术中的这些关系:美国外科医生学会国家手术质量改进计划(NSQIP)查询了反映颈椎前路椎间盘切除和融合术(ACDF)、颈椎后路减压和融合术(PCDF)的当前程序术语(CPT)代码以及涉及的水平数。组群分为 10 组:单层、2 层、3 层、4 层、5 层以上颈椎前路或后路融合术。计算平均手术时间、平均 wRVU 和 wRVU/分钟,并通过学生 t 检验进行比较:共有 100,997 例患者符合纳入标准,其中 79,141 例(78.36%)接受了 ACDF,21,836 例(21.62%)接受了 PCDF。在 ACDF 和 PCDF 中,单层和两层融合最为常见。在1级、3级、4级和5级以上融合中,前路方法的平均wRVU值明显较低(PConclusions:在颈椎手术中,手术方法和融合水平之间存在明显差异,这与手术难度、医生工作量或所需专业知识等指标不符。这些具体结果表明,现有的 RVU 指标无法有效反映多层次颈椎前路融合术的复杂性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of RVU Reimbursement in Anterior or Posterior Approach for Single- and Multilevel Cervical Spinal Fusion.

Study design: Retrospective database study.

Objective: 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.

Summary of background data: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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来源期刊
Clinical Spine Surgery
Clinical Spine Surgery Medicine-Surgery
CiteScore
3.00
自引率
5.30%
发文量
236
期刊介绍: Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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