Operation time

The time interval between the instant of the occurrence of a specified input condition and the instant of completion of a specified operation.

Surgical team familiarity reduces operative time, improves performance 1).

To demonstrate discrepancies between operative times in the ACS NSQIP (ACS National Surgical Quality Improvement Program) and self-reported operative time from the American Medical Association's Relative Value Scale Update Committee (RUC) and their effect on relative value units (RVU) determination.

In a cross-sectional review of registry data using the ACS NSQIP 2016 Participant User File and the Centers for Medicare & Medicaid Services physician procedure time file for 2018. Uppal et al. analyzed total RVUs for surgeries by operative time to calculate RVU per hour and stratified by specialty. Multivariate regression analysis adjusted for patient comorbidities, age, length of stay, and ACS NSQIP mortality and morbidity probabilities. The surgeon self-reported operative times from the Centers for Medicare & Medicaid Services physician were compared with operative times recorded in the ACS NSQIP, with excess time from RUC estimates termed “overreported time.”

Analysis of 901,917 surgeries revealed a wide variation in median RVU per hour between specialties. Orthopedics (14.3), neurosurgery (12.9), and general surgery (12.1) had the highest RVU per hour, whereas gynecology (10.2), plastic surgery (9.5), and otolaryngology (9) had the lowest (P<.001 for all comparisons). These results remained unchanged on multivariate regression analysis. General surgery had the highest median overreported operative time (+26 minutes) followed by neurosurgery (+23.5 minutes) and urology (+20 minutes). Overreporting of the operative time strongly correlated to higher RVU per hour (r=0.87, P=.002).

Despite reliable electronic records, the AMA-RUC continues to use inaccurate self-reported RUC surveys for operative times. This results in discrepancies in RVU per hour (and subsequent reimbursement) across specialties and a persistent disparity for women-specific procedures in gynecology. Relative value units levels should be based on the available objective data to eliminate these disparities 2).

Surgical team familiarity reduces operative time, improves performance. OR Manager. 2014 Jan;30(1):5. PubMed PMID: 24520678.
Uppal S, Rice LW, Spencer RJ. Discrepancies Created by Surgeon Self-Reported Operative Time and the Effects on Procedural Relative Value Units and Reimbursement. Obstet Gynecol. 2021 Jul 8. doi: 10.1097/AOG.0000000000004467. Epub ahead of print. PMID: 34237766.
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