Are Orthopedic Trauma Surgeons Appropriately Compensated for Treating Acetabular Fractures? An analysis of operative times and RVUs

Abstract

OBJECTIVES: To evaluate the work RVUs attributed per minute of operative time (wRVU/min) in fixation of acetabular fractures, evaluate surgical factors that influence wRVU/min, and to compare wRVU/min to other procedures. METHODS: Design: Retrospective Setting: Level 1 academic center Patient Selection Criteria: 251 operative acetabular fractures (62 A, B, C) from 2015 – 2021 Outcome Measures and Comparisons: Work RVU per minute of operative time for each acetabular current procedural terminology (CPT) code. Surgical approach, patient positioning, total room time and surgeon experience were collected. Comparison wRVU/min were collected from the literature. RESULTS: The mean wRVU per surgical minute for each CPT code was (1) CPT 27226 (isolated wall fracture): 0.091 wRVU/min, (2) CPT 27227 (isolated column or transverse fracture): 0.120 wRVU/min, (3) CPT 27228 (associated fracture types): 0.120 wRVU/min. Of fractures with single approaches, anterior approaches generated the least wRVU/min (0.091 wRVU/min, p=0.0001). Average non-surgical room time was 82.1 minutes. Surgeon experience ranged from 3 to 26 years with operative time decreasing as surgeon experience increased (p = 0.03). As a comparison, the wRVU/min for primary and revision hip arthroplasty have been reported as 0.26 and 0.249 wRVU/min respectively. CONCLUSIONS: The wRVUs allocated per minute of operative time for acetabular fractures is less than half of other reported hip procedures and lowest for isolated wall fractures. There was a significant amount of non-surgical room time that should be accounted for in compensation models. This information should be utilized to ensure that orthopedic trauma surgeons are being appropriately supported for managing these fractures.