The Relationship Between Relative Value Units and Outcomes: A Multivariate Analysis of Plastic Surgery Procedures

Introduction: Relative value units (RVUs) were developed as a quantifier of requisite training, knowledge, and technical expertise for performing various procedures. In select procedures, increasing RVUs have been shown to substitute well for increasing surgical complexity and have been linked to greater risk of complications. The relationship of RVU to outcomes has yet to be examined in the plastic surgery population. Methods: This study analyzed nearly 15,000 patients from a standardized, multicenter database to better define the link between RVUs and outcomes in this surgical population. The American College of Surgeons’ National Surgical Quality Improvement Program was retrospectively reviewed from 2006 to 2010. Results: A total of 14,936 patients undergoing primary procedures of plastic surgery were identified. Independent risk factors for complications were analyzed using multivariable logistic regression. A unit increase in RVUs was associated with a 1.7% increase in the odds of overall complications and 1.0% increase in the odds of surgical site complications but did not predict mortality or reoperation. A unit increase in RVUs was also associated with a prolongation of operative time by 0.41 minutes, but RVUs only accounted for 15.6% of variability in operative times. Conclusions: In the plastic surgery population, increasing RVUs correlates with increased risks of overall complications and surgical site complications. While increasing RVUs may independently prolong operative times, they only accounted for 15.6% of observed variance, indicating that other factors are clearly involved. These findings must be weighed against the benefits of performing more complex surgeries, including time and cost savings, and considered in each patient's risk-benefit analysis.