ACS 2019: Is the Relative Value of Operative Time Equal across Surgical Specialties?

San Francisco, California ( Solomon Hayon, MD, University of North Carolina, Chapel Hill, NC, described their research on measuring how relative value units (RVUs) vary with operative time across surgical specialties. They utilized data from the 2017 ACS-NSQIP database. They identified procedures by primary c and calculated the mean total work RVU (mRVU) for surgical encounters to account for case complexity. In total, over 876,000 cases were analyzed across nine surgical specialties. Cases with concurrent CPTs and CPTs with <50 encounters were excluded. Pearson Correlation Coefficients were estimated at the CPT level, using median operative time and mRVU per CPT. They then estimated the relationship between median operative time and mRVU by specialty.

Overall, median operative time correlated well with mRVU (R2=0.85). The correlation between mRVU and operative time was lowest for cardiac surgery (R2=0.51), and strongest for ENT (R2=0.97). There was a significant relationship between both surgical specialty and operative time with mRVU (all p<0.004). As depicted in Table 1, starting mRVU was highest for Cardiac Surgery (18.0) and lowest for Orthopedics (-0.51). Neurosurgery had the greatest increase in mRVU per minute of operative time (slope=0.21).


In conclusion, surgeon productivity and income are increasingly based on work RVUs. While mean total work RVU correlates well with operative time overall, there appear to be disparities according to surgical specialty, which may yield inequities in physician compensation.

Presented by: Solomon Hayon, MD, UNC School of Medicine, University of North Carolina, Chapel Hill, North Carolina

Written by: Stephen B. Williams, MD, Medical Director for High Value Care; Chief of Urology, Associate Professor, Director of Urologic Oncology, Director Urologic Research, The University of Texas Medical Branch at Galveston, TX at the 2019 American College of Surgeons (ACS), #ACSCC19, October 27–31 in San Francisco, California