Correlation Between Relative Value Units and Operative Time in Hand Surgery

- Edward Reece , Christopher Conlon, Kausar Mukhi, Sebastian Winocour


The goal of the relative value unit (RVU) system is to supply standardized fees for medical services that are relative to the cost of the resources. For the hand surgeon, the most finite resource is time. A retrospective analysis of de-identified patient data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data Files (PUFs) was performed to assess the correlation between operative times and the corresponding RVU designations for those Current Procedural Terminology (CPT) codes. All procedures from 2011 to 2018 for which the surgical specialty was listed as “Plastics” or “Orthopedics” were included. In order to get an accurate measure of operative time for each procedure, only “standalone” procedures were included in the final analysis—those procedures for which the CPT codes entered in the database were an exact match. The final cohort included 17 unique CPT codes and 26 unique procedures, for a total of 29,506 hand surgeries that met criteria for inclusion. The relationship between operative time and RVUs was positively correlated (linear regression R2 0.79). The most RVU generated per minute was a bilateral ligamentous reconstruction with tendon interposition providing 0.255 RVU/min, 0.087 RVU/min more than expected. The least RVU generated per minute was a proximal row carpectomy providing 0.109 RVU/min, 0.060 RVU/min less than expected. Procedures that were more efficient for RVU generation included those that were bilateral and those that were primarily soft tissue.