Understanding trends in inpatient surgical volume: vascular interventions, 1980-2000.
OBJECTIVE
To help understand past and future trends in vascular intervention, we examined changes in the rate of utilization, patient demographics, and length of stay from 1980 to 2000.


METHODS
We reviewed the ICD-9 codes for all vascular procedures using the National Hospital Discharge Survey of non-federal United States hospitals (1980-2000).


RESULTS
The number of vascular procedures performed in this country increased from 412,557 in 1980 to 801,537 in 2000 (per capita increase of >50%). This increase was most evident in elderly patients (>75 years, 67% per capita increase in discharges). Long hospital stays (> or =7 days) for vascular procedures fell 41%, and short hospital stays (<24 hours) increased 15% over the period of study. The frequency of abdominal aortic aneurysm repairs remained relatively constant. Except for an interval in the late 1980s, and a minor decrease from 1997 to 2000, the frequency of carotid endartarectomy rose dramatically (69%). Lower extremity revascularizations increased steadily until 1990 but then declined 12%. From 1995 to 2000, there was a 27% per capita decrease in the number of renal-mesenteric operations. Correspondingly, over the past 5 years there has been a 979% growth in the number of percutaneous/endovascular interventions. Despite a substantial number of interventions for lower extremity vascular disease, there was a concomitant increase in the number of major and minor amputations.


CONCLUSIONS
Interventions for vascular disease have increased dramatically, with a major shift toward less invasive treatments, particularly for the renal and mesenteric vessels and the lower extremities. These trends in procedural use suggest that vascular surgeons need to embrace catheter-based approaches if they want to remain leaders in the treatment of peripheral vascular diseases.
Anderson
Patrice L
PL
International Center for Health Outcomes and Innovation Reseach (InCHOIR), New York Presbyterian Hospital, Department of Surgery, 600 W. 168th Street, New York, NY 10032, USA. patricea@inchoir.org
Gelijns
Annetine
A
Moskowitz
Alan
A
Arons
Ray
R
Gupta
Lopa
L
Weinberg
Alan
A
Faries
Peter L
PL
Nowygrod
Roman
R
Kent
K Craig
KC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D032882:Comprehension; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends; D010351:Patient Discharge / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000145:classification / Q000639:trends*