Quantifying the Perioperative Work Associated With Total Hip and Knee Arthroplasty: The Burden Has Increased With Contemporary Care Pathways

Recently, the Centers for Medicare and Medicaid Services (CMS) has labeled the procedural codes for total hip arthroplasty (THA) and total knee arthroplasty (TKA) as potentially misvalued and has asked the American Medical Association (AMA) and its Relative Value Scale Update Committee (RUC) to review this. To assess the validity of this claim, we aimed to catalog the specific service tasks and duration of time required for each task associated with the perioperative care of the patient who underwent primary THA and TKA.

We prospectively timed preservice and immediate postservice activities performed outside of the operating room (OR) by 7 arthroplasty surgeons over a four-week period. Specific timing data for preservice activities performed in the OR were obtained retrospectively from our institutional electronic medical record for 500 patients undergoing THA and 500 undergoing TKA. Results were compared with the current approved values reviewed by the RUC in 2013 and converted to work relative value units (wRVUs) based on the intensity coefficients used by the RUC.

The average total preservice evaluation time was 42.2 minutes. The average time from the patient entering the OR to incision was 40.8 ± 25.4 minute. Immediate postservice tasks took 30.0 minutes. Compared with the 2013 RUC weighted wRVU value of 1.394 for preservice and 0.560 for immediate postservice activities, we found that surgeons actually perform 1.567 wRVUs of preservice and 0.672 of immediate postservice activities.

Policymakers should consider these findings when reviewing the time and intensity spent on perioperative care for patients undergoing THA and TKA.