Open Vascular Surgery Operative Times Are Not Decreasing: Implications for Cms Payment Efficiency Adjustments

Document Type

Conference Proceeding

Publication Date

7-1-2026

Publication Title

J Vasc Surg

Keywords

abdominal aortic aneurysm, adult, aged, aneurysm surgery, carotid artery stenting, carotid artery surgery, carotid endarterectomy, cohort analysis, conference abstract, controlled study, endovascular aneurysm repair, female, human, incision, major clinical study, male, medicaid, medicare, operation duration, revascularization, special situation for pharmacovigilance, surgery, vascular surgery, vascularization, workflow

Abstract

Objectives: The Centers for Medicare and Medicaid Services (CMS) recently introduced an efficiency adjustment to reduce work relative value units for procedural codes, based on the assumption that operative times have declined due to technological and workflow advances. Whether this assumption applies uniformly across all vascular surgery procedures is unknown. Methods: Patients undergoing open and endovascular vascular surgery were identified in the Society for Vascular Surgery Vascular Quality Initiative registry from 2017 to 2024. Procedures were categorized by operative approach. Open vascular reconstructions included abdominal aortic aneurysm repair [OAAA], suprainguinal bypass [SIB], infrainguinal bypass [IIB]), and carotid endarterectomy (CEA). Endovascular procedures included endovascular aneurysm repair [EVAR], thoracic EVAT [TEVAR], transfemoral carotid artery stenting [TfCAS], and transcarotid artery revascularization [TCAR]). Operative duration was defined as incision to closure time. Annual median operative times were calculated for each procedure type, and temporal trends were evaluated using linear regression. Results: A total of 323,731 vascular procedures were included. With the exception of CEA, open vascular reconstructions demonstrated increasing operative times over the study interval from 232.0 to 251.5 minutes, or approximately 8.5% (P < .001) (Fig 1). Specifically, OAAA operative times increased from 234.5 to 251.5 minutes, a 7% increase (P < .001), SIB increased from 248 to 274 minutes, representing an 10.5% increase (P < .001), and IIB increased from 216 to 237 minutes, a 10% increase (P < .001). CEA times decreased slightly from 110 to 107 minutes, a 3% change (P = .041). In contrast, endovascular surgery saw a decrease in operative time from 81 minutes to 71 minutes, a 12% decrease (P < .001) (Fig 2). Specifically, EVAR times decreased from 116.0 to 95.5 minutes, a 17.5% decrease (P < .001), and TEVAR times decreased from 178 to 155 minutes, a 13% decrease (P < .001). When looking at carotid interventions; TfCAS times decreased from 62 to 58 minutes, a 5% decrease (P < .001); and TCAR times decreased from 70 to 60 minutes, a 14% decrease (P < .001). Conclusions: Operative time trends in vascular surgery differ by procedural approach, with increasing durations for most open vascular procedures and decreasing durations for endovascular procedures. These findings challenge the assumption of uniform operative time reductions currently being utilized by CMS. Policy approaches that fail to account for procedure-specific complexity and declining overall experience risk undervaluing open vascular surgery and misaligning physician work valuation. [Formula presented] [Formula presented]

Volume

84

Issue

1

First Page

e301

Last Page

e302

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