A new study published in The Spine Journal examines how relative value units compare for posterior segmental instrumentation of vertebral segments.
Study authors examined 437 patients who underwent surgical procedures with instrumentation at three to six segments; 67 patients who had instrumentation at seven to 12 segments; and 16 patients who had procedures with 13 or more segments instrumented. The study authors examined average operative times, RVU and RVU per minute.
The study authors found:
1. Patients who underwent instrumentation at three to six segments had a shorter operative time, 217 minutes on average, than the patients who had seven or more segments instrumented; patients with instrumentation at seven to 12 segments had an average operative time of 325 minutes and those with 13 or more segments instrumented had an average operative time of 426 minutes.
2. The patients with fewer instrumented segments had lower average RVUs than those with more segments instrumented:
• Three to six segments: 12.6 RVUs
• Seven to 12 segments: 13.4 RVUs
• 13 or more segments: 16.4 RVUs
3. The most RVUs per minute were for patients who underwent instrumentation at three to six levels.
4. The annualized cost difference between patients who had three to six levels instrumented and seven to 12 levels instrumented was $112,432.12; the annualized difference between those who had three to six levels instrumented and those with 13 or more levels instrumented was $176,744.76. The difference between those who had seven to 12 levels instrumented and more than 13 levels instrumented was $64,312.55.
5. Study authors concluded the compensation surgeons receive for instrumented posterior fusions isn't proportional to the additional time and skill needed for the complex cases.