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Relative Value and Complication Rates for Hand Surgery Compared to Other Plastic Surgery Procedures: A CPT-Level National Analysis
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
BACKGROUND: Work relative value units (wRVUs) are meant to capture the time, technical skill, and peri-operative risk that guide Medicare reimbursement, yet several studies have shown that hand procedures receive some of the lowest wRVU return per minute of operative time among all surgical services. Prior analyses, focused largely on orthopaedic data, highlight wide variation within hand surgery itself and suggest that reimbursement may not adequately reflect the complexity of these operations. Whether a similar imbalance exists for hand cases performed by plastic surgeons has not been explored.
METHODS: ACS-NSQIP data from 2015-2019 and 2021-2023 (2020 excluded for COVID disruption) were filtered to cases listed under the plastic-surgery specialty. Fifty hand-specific CPT codes (identified from subspecialty society guidance) were contrasted with 894 non-hand plastic-surgery codes. For every CPT, the mean operative time (minutes) was converted to hours and divided into the 2023 CMS work-RVU to yield wRVU / h; multiplying by the 2023 dollar conversion factor ($36.0896) gave estimated professional dollars per operative hour. Thirty-day CPT-level rates of major complications (composite infectious, thromboembolic, cardiopulmonary and transfusion events), unplanned reoperation, readmission, cardiac arrest, and mortality were calculated. Welch unequal-variance
t tests compared hand versus other plastic-surgery CPT means; significance was set at ? = 0.05. All processing used Python 3.13.4 (pandas 2.2, SciPy 1.13) with DuckDB 0.10 as the in-database engine.
RESULTS: 1 087 363 plastic-surgery cases comprising 944 CPT codes met inclusion. Hand CPTs (n = 50; 46 708 cases) demonstrated lower reimbursement efficiency than other plastic-surgery CPTs (6.23 vs 8.07 wRVU/h,
p = 0.00017). Mean CPT-level outcome rates were significantly lower for hand procedures: major complications 1.86 % vs 4.90% (
p = 0.00014), reoperation 1.06 % vs 3.42 % (
p < 0.00001), readmission 1.74 % vs 3.98 % (
p = 0.0010), and cardiac arrest 0.02 % vs 0.21 % (
p = 0.033). Thirty-day mortality was rare (0% vs 0.49%,
p = 0.32).
CONCLUSION: Hand operations within plastic surgery generate roughly one-quarter fewer work-RVUs per operative hour than other plastic-surgery procedures while demonstrating substantially lower peri-operative morbidity. These findings echo orthopaedic reports and suggest a persistent undervaluation of hand surgery effort in the current Medicare fee schedule. Reassessment of hand-surgery wRVUs is warranted to better align reimbursement with operative time and patient risk.
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