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Is Our Effort Appropriately Valued? An Analysis of Work Relative Value Units in Immediate Breast Reconstruction

Doval, Andres F. MD; Gratzon, Andrew C. MD; Neese, Virginia B. MS; Shuck, John W. MD; Echo, Anthony MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 17-18
doi: 10.1097/01.GOX.0000584288.45499.ea
Breast Abstracts

Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

BACKGROUND: The work relative value units (wRVUs) system was developed as a quantifier of physician labor, technical skill, medical decision-making, and training time required to complete surgical procedures.1 Thus, more complex surgical procedures that require greater technical skills and are more time consuming should yield a greater compensation. Historically, it is known that prosthetic breast reconstruction reimburses considerably more per hour than autologous breast reconstruction.2 However, there are limited data comparing wRVUs and operative times in breast reconstruction procedures.

PURPOSE: This study aims to compare mean operative times and wRVUs per minute across 3 different modalities of breast reconstruction.

METHODS: A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database was performed to identify all patients undergoing implant, pedicle, and free flap–based reconstruction over a 6-year period (2012–2017). Calculation and comparison of mean operative times, wRVUs, and wRVU per minute were performed.

RESULTS: A total of 3,167 patients were included in the analysis. A total of 2,265 (71.5%) underwent immediate implant-based reconstruction, 759 (24%) underwent immediate free flap breast reconstruction, and 143 (4.5%) underwent immediate pedicle flap–based reconstruction. Patients were distributed in unilateral and bilateral cases, and according to the use of acellular dermal matrix during implant-based reconstruction. Consistently, mean operative time was greater for free flap breast reconstruction, followed by pedicle flap and implant-based reconstruction (P < 0.0001). However, wRVU per minute and dollars per minute were found to be higher for prosthetic reconstruction in all comparisons (P < 0.0001).

CONCLUSION: In our analysis, the more complex and time-consuming procedures resulted in a lower reimbursement in dollars and wRVU per minute for the procedure.


1. Nguyen KT, Gart MS, Smetona JT, et al. The relationship between relative value units and outcomes: a multivariate analysis of plastic surgery procedures. Eplasty. 2012;12:e60.

2. Leff DR, Bottle A, Mayer E, et al. Trends in immediate postmastectomy breast reconstruction in the United Kingdom. Plast Reconstr Surg Glob Open. 2015;3:e507.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.