Correlation Between Relative Value Units and Operative Time for Craniofacial Surgeries

Introduction: The work relative value unit (wRVU) determines reimbursement rates for surgical procedures. Studies have shown its inaccuracy in capturing the complexity of certain plastic surgery procedures. Craniofacial surgery requires extensive surgical planning with a multidisciplinary approach. The authors aim to evaluate the wRVUs of craniofacial surgery by correlation to their operative time. Methods: A retrospective study was conducted using CPT codes for craniofacial surgeries from the American College of Surgeons National Surgical Quality Improvement Program database (2005-2021). Efficiency was evaluated by calculating wRVU per unit of operative time. Correlations were analyzed between operative time and both wRVU and wRVU per minute. Results: 82 CPT Codes (9628 procedures) were included. Cranial reconstruction generated the maximum wRVU, while craniofacial masses generated the minimum. Longer operative times were associated with greater wRVUs overall. Cranial reconstruction and facial trauma and reconstruction procedures had moderate negative correlations between operative time and wRVU/min. Cleft procedures had a weak negative correlation to wRVU per minute. Surgeries for craniofacial masses and orthognathic procedures had weak positive correlations. Conclusion: Cranial reconstruction, facial trauma and reconstructions, and cleft surgery had reduced compensation per unit time. This disparity in wRVU allocation craniofacial surgery underscores the need for remuneration reform.