Comparison of physician compensation using work relative value units in septic revision total shoulder arthroplasty

Arman Kishan; Sarah I. Goldfarb; Kiyanna Thomas; Sanjay Kubsad; Ansh Kishan; Jacob D. Mikula; Henry Maxwell Fox; Umasuthan Srikumaran

Journal of Orthopaedic Reports (Dec 2025)

Comparison of physician compensation using work relative value units in septic revision total shoulder arthroplasty

Arman Kishan,
Sarah I. Goldfarb,
Kiyanna Thomas,
Sanjay Kubsad,
Ansh Kishan,
Jacob D. Mikula,
Henry Maxwell Fox,
Umasuthan Srikumaran

Affiliations

Arman Kishan: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA; Corresponding author. Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1924 E Lombard St, 21231, Baltimore, MD, USA.
Sarah I. Goldfarb: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
Kiyanna Thomas: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
Sanjay Kubsad: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
Ansh Kishan: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
Jacob D. Mikula: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
Henry Maxwell Fox: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
Umasuthan Srikumaran: Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA; From the Core Faculty, Hopkins Business of Health Initiative, The Johns Hopkins University, Carey Business School, Baltimore, MD, USA

Journal volume & issue: Vol. 4, no. 4
p. 100471

Abstract

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Background: Revision total shoulder arthroplasty (TSA) for prosthetic joint infection (herein, “septic revision TSA”) requires more time and resources compared with revision in the absence of infection (“aseptic revision TSA”). Physician compensation should accurately reflect this greater burden. In this study, we assessed whether physician compensation for septic revision TSA is proportionate to that for aseptic revision TSA. Methods: The National Surgical Quality Improvement Program database was queried from 2006 to 2021 to identify cases of aseptic and septic revision TSA. Work relative value units (wRVUs), operative time, wRVUs per minute, and compensation per hour were compared between aseptic and septic cases. Univariate and multivariate analyses were conducted to assess wRVU adequacy for septic revision TSA. The wRVU-to-dollar conversion factor was obtained from the US Centers for Medicare & Medicaid Services, and wRVU dollar valuations were calculated. P values < 0.05 were considered significant. Results: Mean (± standard deviation) operative times were 125 ± 62 (range, 21–695) minutes for aseptic revision TSA and 135 ± 58 (range, 30–418) minutes for septic revision TSA (P = .025). wRVUs per minute were 0.26 for aseptic revision TSA and 0.23 for septic revision TSA (P = .002). Compensation per hour was $504 for aseptic revision TSA and $453 for septic revision TSA (P = .002). Conclusions: Current physician compensation for septic revision TSA does not reflect the greater complexity associated with these procedures compared with aseptic revision TSA. This incongruity may discourage surgeons from performing septic revisions, which could result in delayed or inadequate treatment for patients. Our results suggest a need for a more precise system of wRVU assignment in septic revision TSA cases to ensure that surgeons are compensated fairly. Level of evidence: Level III; retrospective study.

Published in Journal of Orthopaedic Reports

ISSN: 2773-157X (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/journal-of-orthopaedic-reports

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