背景:进行初次和翻修全髋关节置换术(THA)和全膝关节置换术(TKA)的外科医生工作量难以量化。美国国家航空航天局任务负荷指数(NASA-TLX)调查旨在量化航空后的经验,并已应用于医疗保健领域。我们的目的是:1)量化执行主要和修订TKA和THA的外科医生所承受的工作量,以及2)将这些值与他们的Medicare和Medicaid服务中心(CMS)报销进行比较。
方法:一项由5名经过研究金培训的成人重建外科医生组成的前瞻性队列完成了NASA-TLX在主要和修订TKA/THA病例后的调查。总共完成了122项调查,其中包括70项TKA(48项初选和22项修订)和55项THA调查(38项初选和17项修订)。记录患者的人口统计学和手术变量。最终NASA-TLX工作负载与2021年CMS工作相对价值单位(RVU)进行了比较。
结果:与主要TKA相比,翻修TKA术中工作量增加176%(P<0.001),精神负担增加233%(P<0.001),增加150%的身体负担(P<0.001)。与初级THA相比,翻修THA术中工作量增加106%(P<0.001),增加96%的精神负担(P<0.001),91%增加了身体负担(P<0.001)。与主要TKA相比,翻修手术时间更长(118对84.5分钟,P=0.05)和THA(150分钟对115分钟,P=0.001)。根据2021年CMS数据,修订TKA和THA需要额外补偿36%和12.3%,分别,并行术中努力。
结论:髋关节置换和膝关节置换会给外科医生带来很大的心理和身体负担,并且CMS会不成比例地补偿。
BACKGROUND: Perceived surgeon workload of performing primary and revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) is challenging to quantify. The National Aeronautics and Space Administration Task Load Index (NASA TLX) survey was developed to quantify experiences following aviation and has been applied to healthcare fields. Our purposes were to 1) quantify the workload endured by surgeons who are performing primary and revision TKA and THA and 2) compare these values to their Center for Medicare & Medicaid Services (CMS) reimbursement.
METHODS: A prospective cohort of 5 fellowship-trained adult reconstruction surgeons completed NASA TLX surveys following primary and revision TKA/THA cases. A total of 122 surveys consisting of 70 TKA (48 primaries and 22 revisions) and 55 THA surveys (38 primaries and 17 revisions) were completed. Patient demographics and surgical variables were recorded. Final NASA TLX workloads were compared to 2021 CMS work relative value units.
RESULTS: Compared to primary TKA, revision TKA had 176% increased intraoperative workload (P < .001), 233% increased mental burden (P < .001), and 150% increased physical burden (P < .001). Compared to primary THA, revision THA had 106% increased intraoperative workload (P < .001), 96% increased mental burden (P < .001), and 91% increased physical burden (P < .001). Operative time was higher in revision versus primary TKA (118 versus 84.5 minutes, P = .05) and THA (150 versus 115 minutes, P = .001). Based upon 2021 CMS data, revision TKA and THA would need to be compensated by an additional 36% and 12.3%, respectively, to parallel intraoperative efforts.
CONCLUSIONS: Revision hip and knee arthroplasty places a major mental and physical workload upon surgeons and is disproportionately compensated by CMS.