A comparison of total shoulder arthroplasty relative value unit rates for osteoarthritis and proximal humerus fracture

Abstract

BackgroundTotal shoulder arthroplasty (TSA) procedures performed for proximal humerus fractures are considered to have higher complications rates and longer operative time than TSA performed for osteoarthritis (OA). However, there exists only one current procedural terminology (CPT) code for TSA, which may not accurately capture the increased work and complexity required for fracture cases. The purpose of this study was to compare TSA work relative value unit (RVU) rates per operative time performed for osteoarthritis and fracture care. MethodsData were collected through the National Surgical Quality Improvement Program (NSQIP) database for the years 2006 to 2018 to identify all patients who underwent primary TSA for either OA or fractures. Work RVU, operation time (skin incision to closure), work RVU per minute, and payment per minute were compared between the osteoarthritis and fracture TSA cohorts. Bivariate and multivariate analyses controlling for patient demographics and comorbidity were utilized to determine whether there existed a reimbursement differential between the two groups. ResultsThe mean operation times for primary TSA for osteoarthritis and fracture were 109 minutes and 122 minutes, respectively (P < .001), resulting in 0.23 and 0.21 wRVU/min, respectively (P < .001). OA TSA cases were valued higher with a dollars per minute of $8.36 compared to $7.42 (P < .001). Multiple regression analysis, controlling for age, gender, race, (body mass index) BMI, and (American Society of Anesthesiologists) ASA class, showed trauma cases were reimbursed $1.33/min less than OA cases (P < .001) ConclusionOn average, TSA performed for fracture care is associated with longer operative times and may require more work compared to elective TSA for OA. These results highlight the need for more precise procedural coding to accurately capture the added effort and operative time required for TSA in the setting of fracture care. Level of EvidenceLevel III, retrospective comparative study.