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.

Abstract

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. 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. 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. 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 III.