No Evidence to Support Lowering Surgeon Reimbursement for Total Joint Arthroplasty Based on Operative Time: An Institutional Review of 12,567 Cases

The Centers for Medicare and Medicaid Services has recently added primary total joint arthroplasty (TJA) codes to the 2019 Potentially Misvalued Codes List. The American Association of Hip and Knee Surgeons and the American Medical Association have called for contemporary data that would assess operative time to inform the decision on reimbursement valuation. Therefore, the purpose of this study was to report total hip arthroplasty (THA) and total knee arthroplasty (TKA) operative times within a large multihospital and physician organizational enterprise to assess stability over time.

The study was a retrospective review (2015-2019) of a prospectively maintained multihospital health system database. A total of 12,567 consecutive TJAs were included (5742 THAs by 16 surgeons; 6825 TKAs by 20 surgeons). Operative time was between incision and completion of wound closure. Descriptive statistics were performed for categorical/continuous variables, and trend analysis was performed to assess if there was a change in time over the study period.

For THA, 43.1% were male, with a mean age of 64.1 ± 11.8 years and a mean BMI of 30.1 ± 6.6. The mean operative time was 96.4 ± 36.8 minutes. For TKA, 39.4% were male, with a mean age of 66.2 ± 9.4 years and a mean BMI of 32.7 ± 6.8. The mean operative time was 103.6 ± 29.9 minutes. Trend analysis demonstrated no significant difference in operative time across the study period.

Our analysis demonstrated that operative time has remained stable, with mean time for THA and TKA consistently within 3.6 minutes of the historical benchmark of 100 minutes. Given these findings in a large institutional cohort, there is no definitive evidence to support changing current procedural valuation for TJA based on operative time.