Back to 2026 Abstracts
Comparison of Reimbursement and Postoperative Outcomes for Hand Procedures Performed by Plastic Versus Orthopedic Surgeons
Krishna Unadkat, MS
1, Pooja Dhupati, MPH
2; Scott L. Hansen, MD
3(1)Mayo Clinic Alix School of Medicine, Scottsdale, AZ, (2)University of Arizona College of Medicine Phoenix, Phoenix, AZ, (3)Plastic and Reconstructive Surgery, University of California, San Francisco, San Francisco, CA
Introduction:Hand procedures are performed by both plastic and orthopedic surgeons, yet differences in reimbursement and complication rates across specialties remain poorly characterized. Prior studies have shown substantial variation in relative value unit (RVU) assignment across surgical subspecialties, with hand surgery frequently among the lower-compensated fields. This study evaluates work RVUs per operative hour (wRVU/h) and postoperative outcomes for identical hand CPT codes performed by plastic versus orthopedic surgeons using national surgical data.
Methods:
Hand-specific CPT codes were identified from a curated list of 82 procedures and linked to the 2023 CMS Physician Fee Schedule to obtain wRVU values. NSQIP data from 2015-2023 were queried for these CPTs, stratifying cases by primary surgical specialty: plastic or orthopedic surgery. For each CPT-specialty pairing, we computed mean operative time, wRVU/h, and complication rates (including reoperation, readmission, cardiac events, and 30-day mortality). Mean differences between specialties were compared using Welch's t-test. Data analysis was performed in Python 3.13 and DuckDB 0.10.
Results:
Across 50 CPT codes performed by plastic surgeons and 52 by orthopedic surgeons, mean wRVU/h was slightly higher for orthopedic surgery (6.79) than plastic surgery (6.23), though the difference was not statistically significant (p = 0.20). CPT-level complication rates were low and comparable across specialties, with no significant differences in major complications (1.86% vs 2.09%, p = 0.75), readmission (1.74% vs 2.12%, p = 0.52), or cardiac events (0.02% vs 0.04%, p = 0.32). Reoperation rates showed a non-significant trend toward higher frequency in orthopaedic cases (1.69% vs 1.06%, p = 0.086). No 30-day mortality events were reported.
Conclusions:
Among identical hand CPTs, plastic and orthopedic surgeons achieve similar work RVU efficiency and postoperative outcomes. These findings suggest that specialty-specific reimbursement discrepancies for hand surgery are minimal when controlling for procedure type. Additional research may help contextualize these patterns in relation to case complexity, care setting, and long-term outcomes.
Back to 2026 Abstracts
