title: National trends in ambulatory surgery for upper extremity fractures: a 10-year analysis of the US National Survey of Ambulatory Surgery.
abstract: BACKGROUND
  Upper extremity fractures are increasing in frequency and have profound socioeconomic implications. The purpose of this study was to assess trends in ambulatory upper extremity fracture fixation in the USA from 1996 to 2006 using data from the National Survey of Ambulatory Surgery (NSAS).
  
  
  METHODS
  The NSAS was used to identify cases of closed forearm, carpal, metacarpal, and phalanx fractures treated with open or closed reduction with internal fixation in 1996 and 2006. Data were analyzed for trends in fracture location, age, gender, facility type, payor status, and anesthesia type. US census data were used to obtain national population estimates.
  
  
  RESULTS
  Over the 10-year study period, there was a 54.4 % increase in the population-adjusted rate of upper extremity fractures treated with internal fixation (34.6 to 53.4 per 100,000 capita). There was a 173 % increase in the age-adjusted rate of patients over 55 years treated with internal fixation. There was a 505 % increase in the number of cases performed at freestanding surgical centers compared to hospital-based facilities. Though the majority of cases involved general anesthesia, regional anesthesia (16.6 versus 20.6 %) and monitored anesthesia care (7.1 versus 11.8 %) increased in frequency. Private insurance groups funded the majority of surgeries in both study years.
  
  
  CONCLUSIONS
  The volume of ambulatory surgery for upper extremity fractures has increased dramatically from 1996 to 2006. Operative treatment of upper extremity fractures has increased markedly. Our analysis provides valuable information for providers and policy-makers for allocating the appropriate resources to help sustain this volume.
authors.affiliation: Department of Orthopaedics, Jackson Memorial Hospital/University of Miami, 1611 NW 12th Ave, Miami, FL 33136 USA.
authors.forename: Amar A
authors.initials: AA
authors.lastname: Patel
authors.affiliation: Department of Orthopaedics, Jackson Memorial Hospital/University of Miami, 1611 NW 12th Ave, Miami, FL 33136 USA.
authors.forename: Leonard T
authors.initials: LT
authors.lastname: Buller
authors.affiliation: Department of Orthopaedics, Jackson Memorial Hospital/University of Miami, 1611 NW 12th Ave, Miami, FL 33136 USA.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Fleming
authors.affiliation: Department of Orthopaedics, Hand and Microvascular Surgery, Miller School of Medicine, University of Miami, 900 NW 17th St, Miami, FL 33136 USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Chen
authors.affiliation: Department of Orthopaedics, Hand and Microvascular Surgery, Miller School of Medicine, University of Miami, 900 NW 17th St, Miami, FL 33136 USA.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Owens
authors.affiliation: Department of Orthopaedics, Hand and Microvascular Surgery, Miller School of Medicine, University of Miami, 900 NW 17th St, Miami, FL 33136 USA ; Department of Surgery, Division of Plastic &Reconstructive Surgery, Miller School of Medicine, 1120 NW 14th St., Miami, FL 33136 USA.
authors.forename: Morad
authors.initials: M
authors.lastname: Askari
keywords: Ambulatory; Fixation; Fractures; National; Trends; Upper extremity