title: Relative value unit impact of complex skin closures to academic surgical melanoma practices.
abstract: BACKGROUND
  Melanoma excisions frequently are associated with significant soft-tissue defects, creating the need for complex closures. These closures could be performed by either surgical oncologists or plastic surgeons. We sought to quantify the relative value units (RVUs) and describe the practice patterns of 2 academic surgical subspecialties after a melanoma excision.
  
  
  METHODS
  After institutional review board approval, a retrospective data analysis of a billing database was conducted on all melanoma patients undergoing an excision and closure by surgical oncology and plastic surgery departments in 2007. Data were obtained using billing records for Current Procedural Terminology diagnosis codes. RVUs were used to quantify the value added to each practice from these closures. The surgical oncologist and patient decided if a plastic surgeon was needed.
  
  
  RESULTS
  A total of 270 closures were performed, 53 (19.9%) primary and 217 (80.1%) complex. The surgical oncologists performed most complex closures (188; 86.6%), and the plastic surgeons performed the remainder (29; 13.4%), generating a total of 1,921 RVUs (1,630 by the surgical oncologists and 291 by the plastic surgeons). For analysis, complex closures were divided among 4 anatomic sites: trunk, upper extremity, lower extremity, and head and neck. Most closures by the surgical oncologists were adjacent tissue rearrangements (155; 82%) and the remainder were skin grafts (33; 18%). Closures by the plastic surgeons were more likely to be a full-thickness skin graft (P < .0027) in the head and neck region (P < .0001), with a higher associated median RVU/case (10.15 compared with 8.44 for the surgical oncologists; P < .0002).
  
  
  CONCLUSIONS
  At our institution, the majority of melanoma closures were performed by surgical oncologists. However, plastic surgery often was involved in more complex closures in the head and neck. This data set quantifies the RVUs added and describes the types of closures performed in an academic melanoma practice.
authors.affiliation: Department of Surgery, Division of General Surgery and Trauma, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Cathleen M Sybert
authors.initials: CM
authors.lastname: Khandelwal
authors.forename: Michael O
authors.initials: MO
authors.lastname: Meyers
authors.forename: Jen Jen
authors.initials: JJ
authors.lastname: Yeh
authors.forename: Keith D
authors.initials: KD
authors.lastname: Amos
authors.forename: Jill S
authors.initials: JS
authors.lastname: Frank
authors.forename: Patricia
authors.initials: P
authors.lastname: Long
authors.forename: David W
authors.initials: DW
authors.lastname: Ollila
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D062109:Dermatologic Surgical Procedures; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data*; D008545:Melanoma / Q000601:surgery*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery*; D016038:Skin Transplantation; D013518:Surgery, Plastic / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States