Work Relative Value Units Comparison Between Foot and Ankle Surgeries and Other Orthopaedic Procedures: A Propensity Score-Matched Analysis.

Abstract

Many orthopaedic foot and ankle (FA) procedures require substantial technical expertise, yet the adequacy of their compensation remains largely unexplored. This study evaluates whether orthopaedic FA surgeries are fairly compensated compared with other orthopaedic procedures. Orthopaedic procedures recorded in the National Surgical Quality Improvement Program (2020 to 2022) were identified using Current Procedural Terminology (CPT) codes, and they were classified as FA or non-FA. Compensation adequacy for FA procedures was assessed by comparing work relative value unit (wRVU), operative time (OT), wRVU per hour (wRVU/hr), and reimbursement rate ($/hr) to non-FA procedures. Patients' demographics, preoperative comorbidities, and postoperative complications were compared between the groups. 1:1 propensity score matching was performed on age, sex, case setting: inpatient versus outpatient, and whether the case was emergent or elective. Analysis of covariance was performed to control the effect of preoperative comorbidities and postoperative complications. Twenty FA CPT codes accounted for 24,773 procedures, whereas 137 non-FA CPT codes accounted for 471,759 procedures. In the propensity score-matched cohorts: 8,899 patients were present in each group. OT was significantly longer in FA procedures than non-FA procedures: 96.55 vs. 86.90 minutes, P < 0.001, yet demonstrated significantly lower wRVUs: 11.35 vs. 14.40, P < 0.001. FA procedures generated significantly lower 8.77 wRVU/hr compared with 13.51 wRVU/hr for non-FA procedures, P < 0.001, translating to $382.25/hr vs. $487.65/hr in reimbursement rate. All findings persisted after analysis of covariance adjusting for the rates of preoperative comorbidities and postoperative complications. Compared with non-FA procedures, FA procedures generate significantly lower wRVU/hr and reimbursement rates ($/hr), despite requiring substantially longer OT. This highlights a systemic undervaluation of FA procedures and supports the need to reevaluate wRVU allocation to better reflect the demands of orthopaedic FA surgery. Level III.