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Research ArticleEndoscopic Minimally Invasive Surgery

Comparative Analysis of Learning Curve, Complexity, Psychological Stress, and Work Relative Value Units for CPT 62380 Endoscopic Lumbar Spinal Decompression vs Traditional Lumbar Spine Surgeries: A Paired Rasch Survey Study

Kai-Uwe Lewandrowski, Heber Humberto Alfaro Pachicano, Rossano Kepler Alvim Fiorelli, John C. Elfar, Stefan Landgraeber, Joachim Oertel, Stefan Hellinger, Álvaro Dowling, Paulo Sérgio Teixeira De Carvalho, Max R. F. Ramos, Helton Defino, João Paulo Bergamaschi, Paul Houle, Nicola Montemurro, Christopher Yeung, Marcelo Brito, Douglas P. Beall, Gerd Ivanic, Zhang Xifeng, Zhen-Zhou Li, Hyeun-Sung Kim, Jin-Sung L. Kim and Morgan P. Lorio
International Journal of Spine Surgery April 2024, 18 (2) 138-151; DOI: https://doi.org/10.14444/8594
Kai-Uwe Lewandrowski
1 Division Personalized Pain Research and Education, Center for Advanced Spine Care of Southern Arizona, Tucson, AZ, USA
2 Department of Orthopaedics, Full Professor, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia
3 Department of Orthopedics at Hospital Universitário Gaffree Guinle, Dr. honoris causa, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
4 National Academy of Medicine of Colombia, Bogotá, D.C., Colombia
5 National Academy of Medicine of Brazil, Rio de Janeiro, RJ, Brazil
MD
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  • For correspondence: business@tucsonspine.com
Heber Humberto Alfaro Pachicano
6 Star Médica, Veracruz, México
MD
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Rossano Kepler Alvim Fiorelli
7 Department of General and Specialized Surgery, Gaffrée e Guinle Universitary Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
MD
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  • ORCID record for Rossano Kepler Alvim Fiorelli
John C. Elfar
8 Department of Orthopedic Surgery, University of Arizona College of Medicine – Tucson Campus, Tucson, AZ, USA
MD
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Stefan Landgraeber
9 Universitätsklinikum des Saarlandes, Klinik für Orthopädie, Homburg, Germany
MD
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Joachim Oertel
10 Universitätsklinikum des Saarlandes Neurosschirurgie Klinikdirektor, Homburg, Germany
MD
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Stefan Hellinger
11 Department of Orthopedic Surgery, Arabellaklinik, Munich, Germany
MD
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Álvaro Dowling
12 Department of Orthopedic Surgery, University of São Paulo, Ribeirão Preto, Brazil
MD
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  • ORCID record for Álvaro Dowling
Paulo Sérgio Teixeira De Carvalho
13 Pain and Spine Minimally Invasive Surgery Service at Gaffree Guinle University Hospital, Rio de Janeiro, Brazil
MD, PHD
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  • ORCID record for Paulo Sérgio Teixeira De Carvalho
Max R. F. Ramos
14 Federal University of the Rio de Janeiro State UNIRIO, Rio de Janeiro, Brazil
15 Orthopedic Clinics at Gaffrée Guinle University Hospital HUGG,, Rio de Janeiro, Brazil
MD, PHD
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Helton Defino
16 Department of Orthopaedic Spine Surgery, University of São Paulo, Ribeirão Preto, Brazil
MD, PHD
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João Paulo Bergamaschi
17 Atualli Spine Care, Sao Paulo, Brazil
MD
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Paul Houle
18 Cape Cod Healthcare, Boston University School of Medicine, Hyannis, MA, USA
MD
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Nicola Montemurro
19 Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
MD, PHD
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Christopher Yeung
20 Desert Institute for Spine Care, Phoenix, AZ, USA
MD
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Marcelo Brito
21 Clínica Articulare, Belem, Brazil
MD
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Douglas P. Beall
22 Comprehensive Specialty Care, Clinical Radiology of Oklahoma, Edmond, OK, USA
MD
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Gerd Ivanic
23 Die Orthopaeden, Graz, Austria
MD
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Zhang Xifeng
24 Department of Orthopedics, First Medical Center, PLA General Hospital, Beijing, China
MD
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Zhen-Zhou Li
25 Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
MD
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Hyeun-Sung Kim
26 Spinartus Hospital Chungdam, Seoul, South Korea
MD, PHD
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Jin-Sung L. Kim
27 Department of Neurosurgery, Seoul St. Mary’s Hospital, Seoul, South Korea
28 College of Medicine, The Catholic University of Korea, Seoul, South Korea
MD, PHD
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Morgan P. Lorio
29 Advanced Orthopedics, Altamonte Springs, FL, USA
MD
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  • Article
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  • Figure 1
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    Figure 1

    A 67-year-old man with an L4/L5 spinal stenosis causing right leg pain due to neurogenic claudication without back pain. Conservative treatments have been exhausted and failed. Imaging demonstrates foraminal and lateral spinal stenosis. An endoscopic decompression of L4/L5 foramen and the lateral canal is contemplated with the endoscopic technique of your choice.

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    Figure 2

    Two examples of outlier-sensitive means statistics (outfit analysis) based on the conventional sum of squared standardized residuals, which is more sensitive to unexpected observations, are shown. Surgeon responses on the difficulty of Current Procedural Terminology (CPT) code 22102 compared with the lumbar endoscopy procedure showed a greater outfit from the model predicted by the Rasch analysis (indicated by the red vertical line) than for CPT code 22869 (green vertical line), thereby suggesting the presence of confounding factors affecting responses on item for CPT code 22102. Infit (not shown in this graph) and outfit data between 0.6 and 1.4 indicate a good fit of the Rasch model. Outside these parameters, confounding factors are likely.

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    Figure 3

    Five hundred forty-two spine surgeons accessed the online survey aimed to obtain objective measures of the learning curve effort to obtain adequate skill level to perform the endoscopic lumbar decompression operation, its psychological intensity and stress on the surgeon, and its associated work effort in comparison to other commonly performed lumbar spinal surgeries based on the input of spine surgeons who perform these procedures. Three hundred twenty-two surgeons started the survey, and 150 submitted a valid survey recording, yielding a completion rate of 43.1%.

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    Figure 4

    The majority of responding spine surgeons were neurosurgeons (43.3%). Orthopedic surgeons comprised 38.6% of the respondents, followed by 15% of surgeons who dedicated their practice entirely to the spine. Only 2.4% of the response came from pain management physicians. Therefore, 96.9% of respondents had a postgraduate education in a surgical specialty. Of the 150 responding surgeons, 84.3% worked in an urban practice setting, 8.7% worked in a suburban environment, followed by 7.1% who worked in a rural area.

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    Figure 5

    Most surgeons were members of professional surgeons organizations including the North American Spine Society (NASS; 26.8%), The Brazilian Spine Society – Sociedade Brasiliera de Columna (SBC; 22%), Inter-American Society for Minimally Invasive Spine Surgery – Sociedad Interamericana de Cirurgia de Columna Minimamente Invasiva (SICCMI; 14.2$), American Association of Neurological Surgeons (AANS; 12.6%), American Academy of Orthopedic Surgeons (AAOS; 12.6%), Society For Minimally Invasive Spine Surgery (SMISS; 12.6%), Congress of Neurological Surgeons (CNS; 11.8%), Sociedad Iberolatinoamericana de Columna (SILACO; 11.0%), Korean Minimally Invasive Spine Society (KOMISS; 8.7%), International Society For The Advancement of Spine Surgery (ISASS; 7.9%), European Spine Society (7.1%), Korean Endoscopic Spine Society (KOSESS; 5.5%), KOMISS (8.7%) American Medical Association (AMA; 3.9%), International Society for Minimal Intervention in Spinal Surgery (ISMISS; 3.9%), Chinese Orthopedic Association (COA; 3.1%), Taiwanese Society of Endoscopy Spine Surgery (TSESS; 3.1%), AO Spine (3.9%), the Arab Spine Society (0.8%), and others, such as Asean MIST, the Mexican Spine Society – Associacion Mexicana de Cirujanos de Columna (AMCICO; 3.1%), Thai Minimally Invasive Spine Society (ThaiMISST; 1.6%), Federation of Latin American Neurosurgery Societies (FLANC 1.6%), Swiss Spine and Swiss Neurosurgical Society (0.6%), Deutsche Wirbelsaulengesellschaft (DWG; 0.6%), and Saudi Association of Neurosurgery (0.8%).

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    Figure 6

    The item response theory (IRT) dichotomous Rasch analysis was employed to assess the learning curve difficulty of endoscopic lumbar decompression surgery compared with other commonly performed spinal surgeries (Table 1). Shown is the resulting Wright plot. On the left, the responding surgeons’ latent traits are written in logits (log odds) as estimates of true intervals of item difficulty and surgeon ability. The surgeons represented by horizontal bars at the top indicated that endoscopic spinal surgery is more complex to learn (positive logits) than those on the bottom (negative logits). On the right, the more challenging comparator surgeries are listed at the top vs the less challenging ones on the bottom. Directly across from 0, those surgeons had a 50% chance of considering the learning curve with endoscopic spine surgery as harder than those described by the comparator CPT code. One logit above suggests an approximately 75% chance that these comparator surgeries were considered more challenging than lumbar endoscopic surgery vs one logit below, which suggests an approximately 25% chance that the comparator surgeries were considered more straightforward than lumbar endoscopic surgery. There were assessment gaps above CPT code 63620 and below CPT code 63005. There were areas of redundancy with CPT codes 22102, 63005, 63047, 63030, 22532, and 22633, suggesting a similar degree of learning curve effort between these surgeries.

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    Figure 7

    The item response theory (IRT) dichotomous Rasch analysis was employed to assess the mental effort and psychological stress of endoscopic lumbar decompression surgery compared with other commonly performed spinal surgeries (Table 1). Shown is the resulting Wright plot. On the left, the responding surgeons’ latent traits are written in logits (log odds) as estimates of true intervals of item difficulty and surgeon mental effort-related stress. The surgeons represented by horizontal bars at the top indicated that endoscopic spinal surgery is more stressful (positive logits) than those on the bottom (negative logits). On the right, the more stressful comparator surgeries are listed at the top vs the less stressful ones on the bottom. Directly across from 0, those surgeons had a 50% chance of considering the mental effort and psychological stress with endoscopic spine surgery as higher than those described by the comparator CPT code. One logit above suggests an approximately 75% chance that these comparator surgeries were considered more stressful than lumbar endoscopic surgery vs one logit below suggests an approximately 25% chance that the comparator surgeries were considered less stressful than lumbar endoscopic surgery. There were assessment gaps above CPT code 22533 and below CPT code 22869. There were areas of redundancy with CPT codes 22533, 22633, 22630, 22532, 22102, and 63030, suggesting a similar degree of stress between these surgeries.

  • Figure 8
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    Figure 8

    The item response theory (IRT) dichotomous Rasch analysis was employed to assess the work effort difficulty of endoscopic lumbar decompression surgery compared with other commonly performed spinal surgeries (Table 1). Shown is the resulting Wright plot. On the left, the responding surgeons’ latent traits are written in logits (log odds) as estimates of true intervals of item difficulty and surgeon ability. The surgeons represented by horizontal bars at the top of the chart indicated that endoscopic spinal surgery requires more work effort (positive logits) than those on the bottom (negative logits). On the right, the more challenging comparator surgeries are listed at the top vs the less challenging ones on the bottom. Directly across from 0, those surgeons had a 50% chance of considering the work effort with endoscopic spine surgery as harder than those described by the comparator CPT code. One logit above suggests an approximately 75% chance that these comparator surgeries were considered more work than lumbar endoscopic surgery vs one logit below suggests an approximately 25% chance that the comparator surgeries were considered less work than lumbar endoscopic surgery. There were assessment gaps above CPT code 22532 and below CPT code 22869. There were areas of redundancy with CPT codes 22102, 63620, 22869, 63047, 22612, 22532, and 22533, suggesting a similar degree of difficulty between these surgeries.

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    Figure 9

    Linear regression scatter plot with mean 95% confidence interval of work-related RVUs vs difficulty of comparator spinal surgeries described by the comparator CPT codes. The Rasch analysis of surgeon ability and procedural difficulty allowed the determination of the appropriately valued RVU number for the lumbar endoscopic decompression procedure at the zero logit point as 18.2464.

Tables

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    Table 1

    CPT codes representative of 2023 work RVUs.

    CPT CodeDescriptorWork RVUs
    22869Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level7.03
    22102Partial excision of posterior vertebral component (eg, spinous process, lamina, or facet) for intrinsic bony lesion, single vertebral segment; lumbar11.08
    63030a Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar12.00
    63047Laminectomy, facetectomy, and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], eg, spinal or lateral recess stenosis), single vertebral segment; lumbar15.37
    63620Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion15.60
    63005Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy, or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis16.43
    22630Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar22.09
    22612Arthrodesis, posterior, or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed)23.53
    22532Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic25.99
    22533Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar24.79
    22633a Arthrodesis, combined posterior, or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar26.80
    • Abbreviations: CPT, Current Procedural Terminology; OWCP, Office of Workers' Compensation Program; RVU, relative value unit.

    • Note: OWCP Medical Fee Schedule—Effective Date: 9 July 2023, Last Update: 18 September 2023.8

    • ↵a From 2018 to the latest OWCP Medical Fee Schedule update on 18 September 2023, the RVU numbers have remained unchanged for most CPT codes listed in Table 1 except for CPT Code 63030, which was reduced from 13.18 (2018) to 12.00 (2023) and CPT code 22633, which was reduced from 27.75 (2018) to 26.80 (2023).

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    Table 2

    Physician learning curve comparisons.

    CPT Description (Code)Endoscopy Is EASIER to LearnEndoscopy Is HARDER to LearnEndoscopy Has an EQUAL Learning CurveI Do Not Perform This Comparative Procedure
    Laminectomy and Spinal Cord Decompression, Lumbar (63047)26%
    (33 responses)
    61.4%
    (78 responses)
    10.2%
    (13 responses)
    2.4%
    (3 responses)
    Partial excision of posterior vertebral component (eg, spinous process, lamina, or facet) for intrinsic bony lesion, single vertebral segment; lumbar (22102)22%
    (28 responses)
    66.1%
    (84 responses)
    7.9%
    (10 responses)
    3.9%
    (5 responses)
    Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace and lumbar (63030)29.9%
    (38 responses)
    55.9%
    (71 responses)
    11.8%
    (15 responses)
    2.4%
    (3 responses)
    Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy, or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis (63005)23.6%
    (30 responses)
    63.8%
    (81 responses)
    8.7%
    (11 responses)
    3.9%
    (5 responses)
    Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion (63620)22.8%
    (29 responses)
    31.5%
    (40 responses)
    3.9%
    (5 responses)
    41.7%
    (53 responses)
    Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level (22869)18.1%
    (23 responses)
    46.5%
    (59 responses)
    4.7%
    (6 responses)
    30.7%
    (39 responses)
    Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar (22630)23.6%
    (30 responses)
    61.4%
    (78 responses)
    8.7%
    (11 responses)
    6.3%
    (8 responses)
    Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) (22612)20.5%
    (26 responses)
    55.9%
    (71 responses)
    13.4%
    (17 responses)
    10.2%
    (13 responses)
    Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic (22532)28.3%
    (36 responses)
    44.9%
    (57 responses)
    10.2%
    (13 responses)
    16.5%
    (21 responses)
    Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar (22533)25.2%
    (32 responses)
    47.2%
    (60 responses)
    11%
    (14 responses)
    16.5%
    (21 responses)
    Arthrodesis, combined posterior, or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar (22633)27.6%
    (35 responses)
    50.4%
    (64 responses)
    7.9%
    (10 responses)
    14.2%
    (18 responses)
    • Abbreviation: CPT, Current Procedural Terminology.

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    Table 3

    Physician mental effort, procedure intensity, and psychological stress comparisons.

    CPT Description (Code)Endoscopy Is EASIER to LearnEndoscopy Is HARDER to LearnEndoscopy Has an EQUAL Learning CurveI Do Not Perform This Comparative Procedure
    Laminectomy and Spinal Cord Decompression, Lumbar (63047)48.8%
    (62 responses)
    40.9%
    (52 responses)
    7.9%
    (10 responses)
    2.4%
    (3 responses)
    Partial excision of posterior vertebral component (eg, spinous process, lamina, or facet) for intrinsic bony lesion, single vertebral segment; lumbar (22102)44.9%
    (57 responses)
    43.3%
    (55 responses)
    8.7%
    (11 responses)
    3.1%
    (4 responses)
    Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar (63030)51.2%
    (65 responses)
    42.5%
    (54 responses)
    4.7%
    (6 responses)
    1.6%
    (2 responses)
    Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis (63005)50.4%
    (64 responses)
    41.7%
    (53 responses)
    6.3%
    (8 responses)
    1.6%
    (2 responses)
    Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion (63620)25.2%
    (32 responses)
    29.9%
    (38 responses)
    4.7%
    (6 responses)
    40.2%
    (51 responses)
    Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level (22869)26.8%
    (34 responses)
    33.9%
    (43 responses)
    8.7%
    (11 responses)
    30.7%
    (39 responses)
    Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar (22630)43.3%
    (55 responses)
    37.8%
    (48 responses)
    11%
    (14 responses)
    7.9%
    (10 responses)
    Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) (22612)37.8%
    (48 responses)
    41.7%
    (53 responses)
    11.8%
    (15 responses)
    8.7%
    (11 responses)
    Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic (22532)39.4%
    (50 responses)
    35.4%
    (45 responses)
    7.9%
    (10 responses)
    17.3%
    (22 responses)
    Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar (22533)42.5%
    (54 responses)
    33.9%
    (43 responses)
    7.1%
    (9 responses)
    16.5%
    (21 responses)
    Arthrodesis, combined posterior, or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar (22633)44.1%
    (56 responses)
    35.4%
    (45 responses)
    10.2%
    (13 responses)
    10.2%
    13 (responses)
    • Abbreviation: CPT, Current Procedural Terminology.

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    Table 4

    Physician work comparison.

    CPT Description (Code)Endoscopy Is EASIER to LearnEndoscopy Is HARDER to LearnEndoscopy Has an EQUAL Learning CurveI Do Not Perform This Comparative Procedure
    Laminectomy and Spinal Cord Decompression, Lumbar (63047)43.3%
    (55 responses)
    47.2%
    (60 responses)
    7.9%
    (10 responses)
    1.6%
    (2 responses)
    Partial excision of posterior vertebral component (eg, spinous process, lamina, or facet) for intrinsic bony lesion, single vertebral segment; lumbar (22102)40.2%
    (51 responses)
    47.2%
    (60 responses)
    9.4%
    (12 responses)
    3.1%
    (4 responses)
    Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy, and/or excision of herniated intervertebral disc; 1 interspace, lumbar (63030)44.9%
    (57 responses)
    42.5%
    (54 responses)
    10.2%
    (13 responses)
    2.4%
    (3 responses)
    Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy, or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis (63005)40.9%
    (52 responses)
    48%
    (61 responses)
    7.9%
    (10 responses)
    3.1%
    (4 responses)
    Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion (63620)25.2%
    (32 responses)
    27.6%
    (35 responses)
    4.7%
    (6 responses)
    42.5%
    (54 responses)
    Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level (22869)27.6%
    (35 responses)
    35.4%
    (45 responses)
    7.1%
    (9 responses)
    29.9%
    (38 responses)
    Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar (22630)40.9%
    (52 responses)
    44.1%
    (56 responses)
    9.4%
    (12 responses)
    5.5%
    (7 responses)
    Arthrodesis, posterior, or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) (22612)37.8%
    (48 responses)
    44.9%
    (57 responses)
    9.4%
    (12 responses)
    7.9%
    (10 responses)
    Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic (22532)40.2%
    (51 responses)
    35.4%
    (45 responses)
    9.4%
    (12 responses)
    15%
    (19 responses)
    Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar (22533)41.7%
    (53 responses)
    35.4%
    (45 responses)
    8.7%
    (11 responses)
    14.2%
    (18 responses)
    Arthrodesis, combined posterior, or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar (22633)38.6%
    (49 responses)
    41.7%
    (53 responses)
    10.2%
    (13 responses)
    9.4%
    (12 responses)
    • Abbreviation: CPT, Current Procedural Terminology.

    • View popup
    Table 5

    Dichotomous Rasch model analysis learning curve endoscopic lumbar decompression.

    Model Fit
    Person ReliabilityMADaP3a P
    Scale0.6910.285<0.001
    Endoscopic Lumbar Learning Curve Item Statistics
    CPT CodeMeasureInfitb Outfitc
    63047−0.9941.2261.310
    22102−1.6620.9910.754
    63030−0.8901.2341.106
    63005−1.7841.1301.017
    63620−0.4821.1661.240
    22869−1.5441.0090.951
    22630−1.1000.7510.498
    22612−1.3180.7260.468
    22532−0.5830.9080.658
    22533−0.9940.8970.658
    22633−0.9940.9880.756
    • Abbreviation: CPT, Current Procedural Terminology.

    • ↵a MADaQ3 = Mean of absolute values of centered Q_3 statistic with P value obtained by Holm adjustment

    • ↵b Infit = Information-weighted mean square based on the χ 2 statistic with each observation weighted by its statistical information (model variance). This is more sensitive to unexpected patterns of observations by persons on items that are roughly targeted on them (and vice versa).

    • ↵c Outfit = Outlier-sensitive means square statistic is more sensitive to unexpected observations by surgeons. Infit and outfit data between 0.6 and 1.4 indicate good fit of the Rasch model. Infit and outfit numbers outside this range suggest the presence of confounding factors, such as for CPT codes 22630 and 22612.

    • View popup
    Table 6

    Dichotomous Rasch model analysis of psychological stress and mental effort endoscopic lumbar decompression.

    Model Fit
    Person ReliabilityMADaQ3a P
    Scale0.7620.2740.01
    Lumbar Endoscopic Psychological Stress and Mental Effort Item Statistics
    CPT CodeMeasureInfitb Outfitc
    63047−0.08271.0031.014
    22102−0.20900.8670.617
    63030−0.20900.8880.728
    630050.29270.8270.594
    63620−0.46441.1600.916
    22869−0.72460.9730.704
    226300.41720.8660.937
    22612−0.08270.6890.375
    225320.41721.1040.792
    225330.66670.9190.542
    226330.66670.9560.607
    • Abbreviation: CPT, Current Procedural Terminology.

    • ↵a MADaQ3 = Mean of absolute values of centered Q_3 statistic with P value obtained by Holm adjustment.

    • ↵b Infit = Information-weighted mean square based on the χ 2 statistic with each observation weighted by its statistical information (model variance). This is more sensitive to unexpected patterns of observations by persons on items that are roughly targeted on them (and vice versa).

    • ↵c Outfit = Outlier-sensitive means square statistic is more sensitive to unexpected observations by surgeons. Infit and outfit data between 0.6 and 1.4 indicate good fit of the Rasch model. Infit and outfit numbers outside this range suggest the presence of confounding factors, such as for CPT codes 63005, 22612, and 22533.

    • View popup
    Table 7

    Dichotomous Rasch model analysis work effort endoscopic lumbar decompression.

    Model Fit
    Person ReliabilityMADaQ3a P
    Scale0.7640.324<0.001
    Endoscopic Lumbar RVU Work Effort Item Statistics
    CPT CodeMeasureInfitb Outfitc
    63047−0.3830.9850.649
    22102−0.6521.2030.874
    63030−0.1180.9200.680
    63005−0.6520.9410.652
    63620−0.6521.2771.889
    22869−0.7890.8480.650
    226300.1430.7820.444
    22612−0.2500.5900.302
    225320.5330.9060.953
    225330.5330.8310.458
    226330.1430.7700.412
    • Abbreviations: CPT, Current Procedural Terminology; RVU, relative value unit.

    • ↵a MADaQ3 = Mean of absolute values of centered Q_3 statistic with P value obtained by Holm adjustment.

    • ↵b Infit = Information-weighted mean square based on the χ 2 statistic with each observation weighted by its statistical information (model variance). This is more sensitive to unexpected patterns of observations by persons on items that are roughly targeted on them (and vice versa).

    • ↵c Outfit = Outlier-sensitive means square statistic is more sensitive to unexpected observations by surgeons. Infit and outfit data between 0.6 and 1.4 indicate good fit of the Rasch model. Infit and outfit numbers outside this range suggest the presence of confounding factors, such as for CPT codes 22630, 22633, and 22612.

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International Journal of Spine Surgery
Vol. 18, Issue 2
1 Apr 2024
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Comparative Analysis of Learning Curve, Complexity, Psychological Stress, and Work Relative Value Units for CPT 62380 Endoscopic Lumbar Spinal Decompression vs Traditional Lumbar Spine Surgeries: A Paired Rasch Survey Study
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Comparative Analysis of Learning Curve, Complexity, Psychological Stress, and Work Relative Value Units for CPT 62380 Endoscopic Lumbar Spinal Decompression vs Traditional Lumbar Spine Surgeries: A Paired Rasch Survey Study
Kai-Uwe Lewandrowski, Heber Humberto Alfaro Pachicano, Rossano Kepler Alvim Fiorelli, John C. Elfar, Stefan Landgraeber, Joachim Oertel, Stefan Hellinger, Álvaro Dowling, Paulo Sérgio Teixeira De Carvalho, Max R. F. Ramos, Helton Defino, João Paulo Bergamaschi, Paul Houle, Nicola Montemurro, Christopher Yeung, Marcelo Brito, Douglas P. Beall, Gerd Ivanic, Zhang Xifeng, Zhen-Zhou Li, Hyeun-Sung Kim, Jin-Sung L. Kim, Morgan P. Lorio
International Journal of Spine Surgery Apr 2024, 18 (2) 138-151; DOI: 10.14444/8594

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Comparative Analysis of Learning Curve, Complexity, Psychological Stress, and Work Relative Value Units for CPT 62380 Endoscopic Lumbar Spinal Decompression vs Traditional Lumbar Spine Surgeries: A Paired Rasch Survey Study
Kai-Uwe Lewandrowski, Heber Humberto Alfaro Pachicano, Rossano Kepler Alvim Fiorelli, John C. Elfar, Stefan Landgraeber, Joachim Oertel, Stefan Hellinger, Álvaro Dowling, Paulo Sérgio Teixeira De Carvalho, Max R. F. Ramos, Helton Defino, João Paulo Bergamaschi, Paul Houle, Nicola Montemurro, Christopher Yeung, Marcelo Brito, Douglas P. Beall, Gerd Ivanic, Zhang Xifeng, Zhen-Zhou Li, Hyeun-Sung Kim, Jin-Sung L. Kim, Morgan P. Lorio
International Journal of Spine Surgery Apr 2024, 18 (2) 138-151; DOI: 10.14444/8594
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Keywords

  • CPT® code 62380
  • RUC
  • Rasch methodology
  • endoscopic surgery
  • Learning curve
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  • psychological stress
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