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 ( greater than or equal to 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. Conclusion: 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.