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Tytuł:
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Patient complexity by surgical specialty does not correlate with work relative value units.
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Autorzy:
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Ramirez JL; Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
Gasper WJ; Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
Seib CD; Department of Surgery, Stanford University, Palo Alto, CA, USA.
Finlayson E; Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
Conte MS; Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
Sosa JA; Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
Iannuzzi JC; Department of Surgery, University of California, San Francisco, San Francisco, CA, USA. Electronic address: .
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Źródło:
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Surgery [Surgery] 2020 Sep; Vol. 168 (3), pp. 371-378. Date of Electronic Publication: 2020 Apr 24.
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Typ publikacji:
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Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: St. Louis, MO : Mosby
Original Publication: St. Louis.
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MeSH Terms:
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Efficiency*
Relative Value Scales*
Specialties, Surgical/*statistics & numerical data
Surgical Procedures, Operative/*statistics & numerical data
Adult ; Aged ; Comorbidity ; Female ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Patient Readmission/statistics & numerical data ; Patient Transfer/statistics & numerical data ; Postoperative Complications/epidemiology ; Quality Improvement ; Retrospective Studies ; Risk Adjustment/statistics & numerical data ; Risk Factors ; Specialties, Surgical/organization & administration ; Surgical Procedures, Operative/adverse effects ; Time Factors
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Grant Information:
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R01 AG044425 United States AG NIA NIH HHS; R21 AG054208 United States AG NIA NIH HHS; R01 AG058616 United States AG NIA NIH HHS; R03 AG060097 United States AG NIA NIH HHS
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Entry Date(s):
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Date Created: 20200428 Date Completed: 20201111 Latest Revision: 20201111
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Update Code:
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20240105
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DOI:
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10.1016/j.surg.2020.03.002
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PMID:
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32336468
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Background: Understanding the differences in how patient complexity varies across surgical specialties can inform policy decisions about appropriate resource allocation and reimbursement. This study evaluated variation in patient complexity across surgical specialties and the correlation between complexity and work relative value units.
Study Design: The 2017 American College of Surgeons National Surgical Quality Improvement Program was queried for cases involving otolaryngology and general, neurologic, vascular, cardiac, thoracic, urologic, orthopedic, and plastic surgery. A total of 10 domains of patient complexity were measured: American Society of Anesthesiologists class ≥4, number of major comorbidities, emergency operation, major complications, concurrent procedures, additional procedures, length of stay, non-home discharge, readmission, and mortality. Specialties were ranked by their complexity domains and the domains summed to create an overall complexity score. Patient complexity then was evaluated for correlation with work relative value units.
Results: Overall, 936,496 cases were identified. Cardiac surgery had the greatest total complexity score and was most complex across 4 domains: American Society of Anesthesiologists class ≥4 (78.5%), 30-day mortality (3.4%), major complications (56.9%), and mean length of stay (9.8 days). Vascular surgery had the second greatest complexity score and ranked the greatest on the domains of major comorbidities (2.7 comorbidities) and 30-day readmissions (10.1%). The work relative value units did not correlate with overall complexity score (Spearman's ρ = 0.07; P < .01). Although vascular surgery had the second most complex patients, it ranked fifth greatest in median work relative value units. Similarly, general surgery was the fifth most complex but had the second-least median work relative value units.
Conclusion: Substantial differences exist between patient complexity across specialties, which do not correlate with work relative value units. Physician effort is determined largely by patient complexity, which is not captured appropriately by the current work relative value units.
(Published by Elsevier Inc.)
Comment in: Surgery. 2020 Sep;168(3):379-380. (PMID: 32653203)
