1Panwar K, 2Huish E, 1Law J, 3Staples J, 4Eisemon E, 5Lum Z
1Doctors Medical Center, Modesto, California, USA; 2San Joaquin General Hospital, Stockton, California, USA; 3Memorial Medical Center, Modesto, California, USA; 4Kaiser Permanente Oakland, Oakland, CA, USA; 5UC Davis Medical Center, Weston, Florida, USA
Introduction
Perceived surgeon workload of performing total hip arthroplasty (THA) is poorly understood and variable in nature. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX) survey was developed to quantify subjective experiences following aviation and has been applied to various healthcare fields. Our purpose is to: 1) quantify the workload endured by surgeons who are performing primary and revision THA and 2) compare these values in relationship to their Center for Medicare & Medicaid Services (CMS) compensation.
Methods
A prospective observational cohort of 5 fellowship-trained adult reconstruction surgeons completed NASA-TLX surveys following conclusion of primary THA (CPT 27130 and 27132) and revision THA (CPT 27134, 27137, and 27138). Survey consists of obtaining self-reported scores on 6 domains: mental demand, physical demand, temporal demand, performance, effort, and frustration. All domains were graded on a 20-point scale (0=lowest, 20=highest). Reference tasks and descriptions were included in order to improve interobserver reliability (figure 1). Final workload scores (0 to 20 points) involved a weighted average of all 6 domains. We excluded from analysis any cases with intraoperative complication. Operative time, surgical indication, patient age, sex, body mass index, and American Society of Anesthesiologist category were recorded. Final NASA-TLX workloads were compared to 2021 CMS data for work relative value units. Statistical analysis was performed using SPSS.
Results
55 surveys (38 primaries and 17 revisions) were completed averaging 7.6 primaries and 3.4 revisions per surgeon. All 6 NASA-TLX domains were significantly higher in revision than primary THA (p<.003, table 1). Revision THA represented a 106% increased workload compared to primary THA (p<0.001), primary 5.26 (CI 0-10.96) vs. revision 10.85 (CI 6.29-15.41). Subgroup analysis was unable to reveal difference in workload based upon indication for primary THA (p=0.332) or revision THA (p=.353). Operative time was higher in revision versus primary THA – 150 vs 115 minutes respectively (p=0.001). Post-hoc power analysis demonstrated likelihood of β-error <.001. Based upon 2021 CMS data, revision THA is compensated 25% lower than actual workload.
Conclusion
Revision THA places a significant workload upon surgeons and is disproportionately compensated by CMS.
