Operation time [Neurosurgery Wiki]

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====== 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]]
((Surgical team familiarity reduces operative time, improves performance. OR
Manager. 2014 Jan;30(1):5. PubMed PMID: 24520678.)).
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To demonstrate discrepancies between [[operative time]]s 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 record]]s, the [[AMA]]-[[RUC]] continues to use inaccurate self-reported RUC [[survey]]s for [[operative time]]s. 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
((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.)).