JAAOS - 2026-07-15 - Journal Article; Comparative Study
Comparative Analysis of Work Relative Value Units in Surgical Treatment of Common Orthopaedic Fractures: Ankle, Distal Radius, and Proximal Hip: A Propensity Score-Matched Comparative Study.
Sun P, Lee W
Topics
Key Takeaway
Ankle fracture fixation generates 10.37 wRVU/hr versus 21.66 for proximal hip and 11.39 for distal radius fixation, indicating ankle fixation is reimbursed at roughly half the rate of hip fracture surgery per operative hour.
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Summary
Using NSQIP 2020–2022 CPT-coded data, this propensity score-matched study compared operative time, wRVU, wRVU/hr, and $/hr across ankle, proximal hip, and distal radius fracture fixations. Ankle fixation had the longest mean operative time (89.16 min) yet the lowest wRVU (10.29), wRVU/hr (10.37), and reimbursement rate ($335.32/hr) of the three groups (all P<0.001). These disparities persisted after adjusting for preoperative comorbidities and postoperative complications in propensity-matched cohorts.
Key Limitation
NSQIP operative time reflects total room time and does not isolate surgeon-specific work time, potentially inflating ankle fixation time due to case complexity or positioning demands unrelated to surgical skill.
Original Abstract
BACKGROUND
Ankle, distal radius, and proximal femur fractures are among the top three most common fractures. Despite the high prevalence and cost of these fractures, the relative valuation of these common fractures within the current US healthcare system has not been evaluated. This study aims to evaluate whether ankle fracture fixation is adequately compensated for in the hospital setting compared with distal radius and proximal femur fractures, using the National Surgical Quality Improvement Program database.
METHODS
Ankle, distal radius, and proximal femur fracture fixations were identified within the National Surgical Quality Improvement Program database from 2020 to 2022 using Current Procedural Terminology codes. The relative valuation between the three fracture fixations was assessed using operative time, work relative value units (wRVUs), wRVU per hour (wRVU/hr), and reimbursement rates ($/hr). A propensity score-matched analysis was performed including age (±2 years) and sex with the ankle fracture group as a reference. Two matched cohorts were constructed: ankle and (1) proximal femur fracture and (2) distal radius fracture. Covariance analysis including postoperative complications and preoperative comorbidities were performed to adjust for their effect on the valuation of compensation metrics.
RESULTS
A total of 15,507 ankle fractures, 51,955 proximal hip fractures, and 11,874 distal radius fractures were included. Compared with other fractures, ankle fracture fixation had a significantly longer operative time (89.16 minutes for ankle vs. 65.32 for proximal hip vs. 71.21 for distal radius; respectively, P < 0.001), lower mean wRVU (10.29 vs. 17.94 vs. 11.55, P < 0.001), wRVU/hr (10.37 vs. 21.66 vs. 11.393, P < 0.001), and reimbursement rate (335.32 vs. 700.75 vs. 385.94, P < 0.001). These trends persisted after adjusting for the rates of preoperative comorbidities and postoperative complication as in propensity score-matched analysis.
CONCLUSION
Our findings suggest that ankle fracture fixation is undervalued in the current wRVU system, pointing to the need to reevaluate wRVU allocation more accurately for the surgical treatment in ankle fracture.
LEVEL OF EVIDENCE
Level III.