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Comparison of Perioperative Management Effort and Work Relative Value Units in the Management of Distal Humerus and
Yagiz Ozdag1, Alexander W Mettler1, Mahmoud Mahmound2
1Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA.
Purpose:
Open reduction and internal fixation (ORIF) of distal humerus fractures (DHFs) has nearly identical work relative value unit (wRVU) compensation compared with distal radius fractures (DRFs). The purpose of this study was to compare perioperative work effort, surgical times, complications, and the frequency of postoperative follow-up care for ORIF DRF and DHF cases.
Methods:
All isolated cases of ORIF DHF and intra-articular DRF in adult patients between 2010 and 2024 from a single, large health care system were reviewed. Baseline demographics, surgical characteristics, complications/reoperations, and postoperative visits/communication were recorded. Work relative value units per minute of surgery (wRVU/min) were calculated for each case relative to their current procedural terminology (CPT) codes and assigned wRVUs: (1) CPT 24545: ORIF extra-articular DHF (13.15 wRVU), (2) CPT 24546: ORIF intra-articular DHF (14.91wRVU), (3) CPT 25608: ORIF intra-articular DRF, two fragments (11.07 wRVU), and (4) CPT 25609: ORIF intra-articular DRF, ≥3 fragments (14.38 wRVU). A 1:1 matched cohort was constructed to make comparisons between groups.
Results:
A total of 75 DHF and 74 DRF cases were included. Baseline demographics were similar. Distal humerus fractures had significantly longer mean surgical times (183 minutes) compared with DRFs (92 minutes). Distal humerus fracture cases had a mean wRVU/min of 0.093/min compared with DRF (0.154/min), and this difference was statistically significant. Distal humerus fracture cases also demonstrated significantly higher complication/reoperation rates (23% and 21%) compared with DRFs (6.8% and 6.8%). Both groups had similar frequencies of postoperative visits (mean = 3.0), and ORIF DHF cases had significantly more postoperative phone calls (mean = 2.6) compared with DRF cases (mean = 1.0).
Conclusions:
Considering the longer surgical times and complication rates, upper-extremity surgeons are not proportionally compensated from a wRVU perspective for DHF management compared with DRFs.
Clinical Relevance:
These data should be used in future analyses and advocacy efforts related to wRVU adjustments for DHFs.
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