The Association Between Total Relative Value Unit and 90-Day Mortality After Noncardiac Surgery: A Hospital Data Registry Study

Abstract

Objective. The total relative value unit (TRVU) of surgery reflects surgical complexity. However, its impact on mortality after noncardiac surgery has not been identified. This study aimed to investigate the association of TRVUs for surgery with postoperative 90-day mortality in adult patients who received planned, elective noncardiac surgery. We hypothesized that higher TRVU was associated with an increase in 90-day mortality after noncardiac surgery. Method. This retrospective cohort study analyzed medical records of adult patients admitted to a single tertiary academic hospital between January 2012 and December 2018 for planned elective noncardiac surgery. The primary end point was 90-day mortality. Results. A total of 112 606 patients were included. Among them, 561 patients (.5%) exhibited mortality within 90-days. In the multivariable model, an increase of 10 000 points of TRVUs was not significantly associated with 90-day mortality (odds ratio: .98, 95% confidence interval: .93 to 1.04; P = .536). Additionally, when it was divided into 4 quartile groups (Q1, Q2, Q3, and Q4), Q2, Q3, and Q4 group of TRVUs were not associated with 90-day mortality compared to the Q1 group of TRVUs (P = .058, .984, and .237, respectively). In receiver-operating characteristic analysis, the area under the curve of TRVUs for a 90-day mortality rate was .61. Conclusions. In conclusion, TRVUs were not associated significantly with a 90-day mortality rate after noncardiac surgery and have a low predictive ability for 90-day mortality after noncardiac surgery alone.

Keywords

neurosurgery gastric surgery evidence-based medicine/surgery colorectal surgery

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References

Lave

Pashos

Anderson

, et al. Costing medical care: Using medicare administrative data. Med Care. 1994;32:JS77-89.

Hsiao

Braun

Becker

Thomas

. The Resource-based relative value scale. Toward the development of an alternative physician payment system. JAMA. 1987;258(6):799-802.

Baadh

Peterkin

Wegener

Flug

Katz

Hoffmann

. The relative value unit: History, current use, and controversies. Curr Probl Diagn Radiol. 2016;45(2):128-132.

Hsiao

Stason

. Toward developing a relative value scale for medical and surgical services. Health Care Financ Rev. 1979;1(2):23-38.

Paruch

Merkow

Bentrem

, et al. Impact of hepatectomy surgical complexity on outcomes and hospital quality rankings. Ann Surg Oncol. 2014;21(6):1773-1780.

Nguyen

Gart

Smetona

Aggarwal

Bilimoria

Kim

. The relationship between relative value units and outcomes: A multivariate analysis of plastic surgery procedures. Eplasty. 2012;12:e60.

Park

J-W

Shin

H-J

H-S

A-Y

Hwang

J-W

. Perioperative sedative use is not associated with acute kidney injury after total hip or knee arthroplasty. Ann Transl Med. 2019;7(11):237.

Yoo

Lee

, et al. Seoul National University Bundang Hospital’s electronic system for total care. Healthc Inform Res. 2012;18(2):145-152.

Hsiao

Braun

Dunn

, et al. An overview of the development and refinement of the resource-based relative value scale. The foundation for reform of US physician payment. Med Care. 1992;30:NS1-NS12.

10.

Charlson

Szatrowski

Peterson

Gold

. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245-1251.

11.

Pedersen

Mikkelsen

Cronin-Fenton

, et al. Missing data and multiple imputation in clinical epidemiological research. Clin Epidemiol. 2017;9:157-166.

12.

Hackett

De Oliveira

Jain

Kim

JYS

. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg. 2015;18:184-190.

13.

Birim

Kappetein

Bogers

. Charlson comorbidity index as a predictor of long-term outcome after surgery for nonsmall cell lung cancer. Eur J Cardiothorac Surg. 2005;28(5):759-762.

14.

Kirkland

Kashiwagi

Burton

Cha

Varkey

. The Charlson comorbidity index score as a predictor of 30-day mortality after hip fracture surgery. Am J Med Qual. 2011;26(6):461-467.

15.

Ghaferi

Birkmeyer

Dimick

. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009;361(14):1368-1375.

16.

Jakobson

Karjagin

Vipp

, et al. Postoperative complications and mortality after major gastrointestinal surgery. Medicina. 2014;50(2):111-117.

17.

Roche

JJW

Wenn

Sahota

Moran

. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: Prospective observational cohort study. BMJ. 2005;331(7529):1374.

18.

Shah

Bold

Yang

Khatri

Martinez

Canter

. Relative value units poorly correlate with measures of surgical effort and complexity. J Surg Res. 2014;190(2):465-470.

19.

Turrentine

Wang

Simpson

Jones

. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203(6):865-877.

20.

Lidsky

Thacker

JKM

Lagoo-Deenadayalan

Scarborough

. Advanced age is an independent predictor for increased morbidity and mortality after emergent surgery for diverticulitis. Surgery. 2012;152(3):465-472.

21.

Musallam

Tamim

Richards

, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: A retrospective cohort study. Lancet. 2011;378(9800):1396-1407.

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