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 study claims that operative times and patient complexity for most surgical procedures increased or stayed the same from 2019 to 2023, so CMS's proposed efficiency adjustment to surgical pay is not supported by registry data. All three tests pass.
Independently Verifiable
Pass
Skin-to-skin time is a stopwatch measurement anyone in the room could take with no theory at all.
Falsifiable
Pass
If operative times had fallen, the data would have shown it and the CMS rationale would have been confirmed.
Non-Circular
Pass
The clock that timed the surgeries was not built from any assumption about what the study would find.
Why
The primary outcome is how long surgeries took, measured skin to skin. That is elapsed time. A person with a stopwatch and no opinion about Medicare policy could have recorded the same numbers. The comparison is between 2019 and 2023 across the same procedure codes, and the result could have gone either way: if times had dropped, the paper would have reported that and supported the payment cut. It did not go that way, and the authors say so plainly. Patient age and death counts are arithmetic on recorded events. The complication and comorbidity labels are registry filing categories, not a theory doing the measuring, and the headline claim does not lean on them. Nothing in the design decided the answer before the data arrived.
2·Paradigm · Basic Epidemiological Comparison
The three tests do not apply. There is no theoretical framework.
NOT APPLICABLE
Why
This study does not depend on a disease model to function. It compares how long operations took in two years and how many patients died, using a surgical registry as a filing cabinet of recorded events. The registry codes are labels on things that happened: an incision, a closure, a death within 30 days. Someone who rejects every theory in medicine could read the same durations and reach the same conclusion about whether surgeries got faster. Because no framework's claims had to be accepted before the numbers could exist, there is no paradigm to score here, and the study verdict stands on its own.
From the study
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, or 0.8% per year (95% CI 0.7% to 0.8% per year, p < 0.001).
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.