2025 · Journal of the American College of Surgeons
Longitudinal Trends in Efficiency and Complexity of Surgical Procedures: Analysis of 1.7 Million Operations Between 2019 and 2023
Verdict
SCIENTIFIC
The study follows the scientific method and does not operate inside a theoretical framework. The verdict is scientific.
1·Study methodology · no theoretical framework
SCIENTIFIC
Follows the scientific method. No theoretical framework attached.
2·Paradigm · Basic Epidemiological Comparison
NOT APPLICABLE
No theoretical framework. The study verdict decides.
How the verdict is decided
This study does not operate inside a theoretical framework. Using hospital records, billing codes, or diagnostic names as labels on visible events is not the same as depending on that framework. The verdict is the study methodology score alone.
1·Study methodology
Did this study test its claim with methods that are independent, falsifiable, and non-circular?
SCIENTIFIC
This paper claims that surgical operative times have stayed the same or increased from 2019 to 2023 and patient complexity has increased, so the proposed Medicare efficiency adjustment is not supported by registry data. All three tests pass.
Independently Verifiable
Pass
The primary outcome is how long a surgery takes from skin cut to skin closed, and anyone with a stopwatch can verify that without accepting any medical theory.
Falsifiable
Pass
The study compared two years of recorded operative times and could have found that surgeries got faster, which would have supported the CMS rationale instead of contradicting it.
Non-Circular
Pass
A clock measuring surgical duration does not assume the conclusion that surgical times increased, and the registry data was collected for clinical purposes before anyone asked this policy question.
Why
The study pulled operative time records from a national surgical registry for 2019 and 2023 and compared them. The primary measurement is skin-to-skin time, which is a stopwatch reading. Someone in the operating room wrote down when the first cut happened and when the closing finished. That record does not require any disease model, any lab test, or any theoretical framework to exist. It is a duration. The study also tracked patient age and 30-day mortality, both of which are physical facts. Some secondary complexity measures use diagnostic labels like comorbidities, which carry medical assumptions, but the central claim rests on operative time. The study could have found that times decreased. It found they increased. That result would have supported the CMS policy proposal, and the study would have reported it the same way. The data source was not built to answer this question. The registry exists for surgical quality improvement. The comparison is arithmetic on recorded durations. Nothing in the design presupposes the answer.
2·Paradigm · Basic Epidemiological Comparison
The three tests do not apply. There is no theoretical framework.
NOT APPLICABLE
Why
The study's method is comparing how long surgeries took in two different years. That is arithmetic on recorded durations. No disease model, no biological framework, and no theoretical claim about the body is required to time a surgery or to count whether a patient survived 30 days. The NSQIP registry is a clinical database used as raw data, not as a theoretical commitment. A stranger who rejects every medical model ever proposed could still read the operative time field, compare 2019 to 2023, and reach the same conclusion. Because the method does not depend on a paradigm's theoretical claims, there is no framework to score. The study verdict alone determines the final result.
From the paper
The primary outcome was surgical efficiency, defined as skin-to-skin operative time.
Overall, operative times increased by 3.1% (95% CI 3.0% to 3.3%, p < 0.001) in 2023 compared with 2019
The rationale for an efficiency adjustment to the Medicare physician fee schedule for surgical procedures is not supported by objective data from a national surgical registry.