title: Inpatient procedures in elderly women: an analysis over time.
abstract: OBJECTIVE
  To describe inpatient surgical and diagnostic/therapeutic procedures in women ≥65 years old and assess procedure trends over time.
  
  
  METHODS
  Procedure data for all women ≥65 years was collected using the National Hospital Discharge Survey, a federal dataset drawn from a representative sampling of U.S. inpatient hospitals which includes patient and hospital demographics and ICD-9-CM diagnosis and procedure codes for admissions from 1979 to 2006.
  
  
  METHODS
  Age-adjusted rates (AAR) per 1000 women were created using 1990 U.S. Census data to compare trends over time.
  
  
  RESULTS
  Over 96 million procedures were performed in women age≥65 years from 1979 to 2006. Women age≥65 years constituted 17% of women with ≥1 inpatient procedure in 1979, rising to 32% in 2006. The most common surgical procedures were lower extremity joint replacement, open reduction internal fixation, and cholecystectomy. The most common concurrent diagnosis was femoral neck fracture. Women with femoral neck fracture were more likely to undergo open reduction internal fixation compared to joint replacement. AARs for ORIF fell from 4.3 to 3.2 (p=.02) from 1979 to 2006, while AARs for joint replacement increased from 0.2 to 3.4 (p≤.001, 1979-1988; p=.14, 1990-2006).
  
  
  CONCLUSIONS
  The rate of women age≥65 years undergoing inpatient procedures has increased dramatically in the last 30 years. Hip fracture was the most common diagnosis for elderly women, highlighting the impact of osteoporosis and falls and the importance of prevention strategies and optimization of peri-operative care in this population. Further comparative study of hip fracture treatment strategies in this population is needed.
authors.affiliation: Division of Urogynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh-School of Medicine, Pittsburgh, PA 15213, United States.
authors.forename: Sallie S
authors.initials: SS
authors.lastname: Oliphant
authors.forename: Chiara
authors.initials: C
authors.lastname: Ghetti
authors.forename: Richard L
authors.initials: RL
authors.lastname: McGough
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Clareann H
authors.initials: CH
authors.lastname: Bunker
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Lowder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data*; D002763:Cholecystectomy / Q000706:statistics & numerical data; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology* / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D050723:Fractures, Bone / Q000453:epidemiology* / Q000628:therapy; D019538:Health Care Surveys; D006620:Hip Fractures / Q000453:epidemiology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007297:Inpatients; D035002:Lower Extremity
keywords: AAR; AOA; Administration on Aging; Elderly; ICD-9-CM; Inpatient procedures; International Classification of Diseases, 9th review, Clinical Modification; NHDS; National Hospital Discharge Survey; ORIF; Women; age-adjusted rate; open reduction internal fixation