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Healthcare Cost and Utilization Project (HCUP). HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2009 [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011.

Cover of HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2009

HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2009 [Internet].

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INPATIENT HOSPITAL STAYS BY PROCEDURE

HIGHLIGHTS

  • The rate of stays with procedures remained relatively stable at about 1,300 stays per 10,000 population from 1997 to 2009.
  • Blood transfusion occurred in over ten percent of all hospital stays that included a procedure and was the most frequently performed procedure in 2009. The rate of blood transfusion more than doubled from 1997 to 2009.
  • Cesarean section was the most frequent major operating room procedure performed on 1.4 million females in 2009.
  • The rate of stays with knee arthroplasty increased 84 percent from 12 per 10,000 population in 1997 to 22 per 10,000 population in 2009. Knee arthroplasty was the fourteenth most common inpatient procedure in 2009.
  • The rate of respiratory intubation and mechanical ventilation grew rapidly from 1997 to 2009 among 45–64 year olds (69 percent), 65–84 year olds (33 percent), and seniors 85 years and older (28 percent).
  • Diagnostic cardiac catheterization and coronary arteriography was common for 45–64 year olds (638,000 procedures) and 65–84 year olds (664,000 procedures), but the rate of procedures declined about 20 percent from 1997 to 2009 in both age groups.

EXHIBIT 3.1. Most Frequent All-listed Procedures

Number of Stays, Stays per 10,000 Population, and Growth of the Most Frequent All-listed Procedures for Hospital Stays, 1997 and 2009*

Download this table as an MS Excel spreadsheet (406K)

ALL-LISTED CCS PROCEDURESNUMBER OF STAYS WITH THE PROCEDURE IN THOUSANDSSTAYS PER 10,000 POPULATION WITH THE PROCEDURECUMULATIVE GROWTH IN RATE
19972009199720091997–2009
All stays (with and without procedures)34,67939,4351,2781,2841%
All stays with any procedure21,25724,7307838063%
 Percent of all stays with a procedure61%63%
  Blood transfusion1,0972,8294092128%
  Prophylactic vaccinations and inoculations5671,7962159180%
  Respiratory intubation and mechanical ventilation9191,498344944%
  Diagnostic cardiac catheterization, coronary arteriography1,4611,4765448−11%
  Cesarean section8001,382294553%
  Repair of obstetric laceration1,1371,34342444%
  Upper gastrointestinal endoscopy1,1051,2424140−1%
  Circumcision1,1641,1744338−11%
  Artificial rupture of membranes to assist delivery747932283010%
  Fetal monitoring1,0028603728−24%
  Hemodialysis473837172756%
  Echocardiogram632813232614%
  Percutaneous transluminal coronary angioplasty (PTCA)58169321235%
  Knee arthroplasty329686122284%
  Enteral and parenteral nutrition277576101984%
  Colonoscopy and biopsy5315642018−6%
  Laminectomy, excision intervertebral disc42550416165%
  Hysterectomy5874832216−27%
  Incision of pleura, thoracentesis, chest drainage349476131620%
  Cholecystectomy and common duct exploration4484601615−9%

2009 stays per 10,000 population are not statistically different from 1997 stays per 10,000 population at p<0.05.

Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997 and 2009.

The rate of stays with procedures remained relatively stable at about 1,300 stays per 10,000 population from 1997 to 2009. About two-thirds of hospital stays involved at least one procedure.

  • Blood transfusion occurred in over ten percent of all hospital stays that included a procedure and was the most frequently performed procedure in 2009. The rate of blood transfusion more than doubled from 1997 to 2009.
  • Vaccinations were the second most frequent procedure performed in 2009. The rate of stays with vaccinations, typically hepatitis B immunizations for liveborn infants, increased by 180 percent from 1997 to 2009.
  • The rate of stays with cardiac catheterization, the fourth most common procedure in 2009, remained relatively stable from 1997 to 2009, at about 50 per 10,000 population.
  • Cesarean section was the most frequent major operating room procedure performed on 1.4 million females in 2009.
  • The rate of stays with knee arthroplasty increased 84 percent from 12 per 10,000 population in 1997 to 22 per 10,000 population in 2009. Knee arthroplasty was the fourteenth most common inpatient procedure in 2009.

Number of Stays, Stays per 10,000 Population, and Growth of Selected All-listed Procedures for Hospital Stays, 1997 and 2009

Download this table as an MS Excel spreadsheet (402K)

ALL-LISTED CCS PROCEDURESNUMBER OF STAYS WITH THE PROCEDURE IN THOUSANDSSTAYS PER 10,000 POPULATION WITH THE PROCEDURECUMULATIVE GROWTH IN RATE
19972009199720091997–2009
Procedures with most rapid growth in stays per population*
 Indwelling catheter6020327198%
 Prophylactic vaccinations and inoculations5671,7962159180%
 Blood transfusion1,0972,8294092128%
 Spinal fusion20244871596%
 Incision and drainage, skin and subcutaneous tissue1182484885%
 Knee arthroplasty329686122284%
 Enteral and parenteral nutrition277576101984%
 Hemodialysis473837172756%
 Cesarean section8001,382294553%
 Respiratory intubation and mechanical ventilation9191,498344944%
 Hip replacement291438111433%
*

Includes only procedures with at least 100,000 stays in either 2009 or 1997. 2009 stays per 10,000 population are statistically different from 1997 stays per 10,000 population at p<0.05.

Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997 and 2009.

The majority of the top ten most rapidly growing all-listed procedures were also among the most frequent procedures.

  • Stays with indwelling catheter approximately tripled from 1997 to 2009, increasing from 2 stays per 10,000 population in 1997 to 7 stays per population in 2009.
  • The rate of hospitalizations with spinal fusion doubled from 7 stays per 10,000 population in 1997 to 15 stays per 10,000 population in 2009.
  • The rate of stays with hip replacement grew 33 percent, from 11 stays per 10,000 population in 1997 to 14 stays per 10,000 population in 2009.
EXHIBIT 3.1 Most Frequent All-listed Procedures. 3.1c Hospital stays per 10,000 population with all-listed blood transfusion, 1997 through 2009. Hospital stays per 10,000 population with all-listed blood transfusion, 1997 through 2009. Line chart. Stays per 10,000 population. 1997: 40; 1998: 45; 1999: 44; 2000: 49; 2001: 60; 2002: 61; 2003: 68; 2004: 76; 2005: 80; 2006: 80; 2007: 87; 2008: 90; 2009: 92. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997–2009.

Hospital Stays per 10,000 Population with All-listed Blood Transfusion, 1997–2009

Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997–2009.

Download this figure as an MS Excel spreadsheet (400K)

  • The rate of stays with all-listed blood transfusion has increased at a relatively steady rate from 40 stays per 10,000 population in 1997 to 92 stays per 10,000 population in 2009.
EXHIBIT 3.1 Most Frequent All-listed Procedures. 3.1d Hospital stays per 10,000 population with all-listed spinal fusion, 1997 through 2009. Hospital stays per 10,000 population with all-listed spinal fusion, 1997 through 2009. Line chart. Stays per 10,000 population. 1997: 7; 1998: 8; 1999: 8; 2000: 9; 2001: 10; 2002: 11; 2003: 11; 2004: 11; 2005: 12; 2006: 12; 2007: 12; 2008: 14; 2009: 15. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997–2009.

Hospital Stays per 10,000 Population with All-listed Spinal Fusion, 1997–2009

Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997–2009.

Download this figure as an MS Excel spreadsheet (400K)

  • The rate of stays with all-listed spinal fusion increased at a relatively steady rate from 7 stays per 10,000 population in 1997 to 15 stays per 10,000 population in 2009.

EXHIBIT 3.2. Most Frequent All-listed Procedures by Age

Number of Stays, Stays per 10,000 Population, and Growth of the Most Frequent All-listed Procedures for Hospital Stays by Age, 1997 and 2009*

Download this table as an MS Excel spreadsheet (410K)

AGE GROUP AND ALL-LISTED CCS PROCEDURESNUMBER OF STAYS IN THOUSANDSSTAYS PER 10,000 POPULATIONCUMULATIVE GROWTH IN RATE
19972009199720091997–2009
All ages, total stays34,67939,4351,2781,2841%
< 1 year, total stays4,4264,67811,79910,9777%
  Prophylactic vaccinations and inoculations5491,5161,4633,556143%
  Circumcision1,1591,1703,0892,746−11%
  Respiratory intubation and mechanical ventilation163176434414−5%
  Enteral and parenteral nutrition39122104287176%
  Diagnostic spinal tap14785391199−49%
1–17 years, total stays1,8211,61127122915%
  Appendectomy748411128%
  Repair of obstetric laceration585398−13%
  Blood transfusion26474770%
  Cancer chemotherapy433865−15%
  Respiratory intubation and mechanical ventilation3034457%
18–44 years, total stays9,4449,9228608742%
  Cesarean section7731,3497011969%
  Repair of obstetric laceration1,0791,2899811416%
  Artificial rupture of membranes to assist delivery706899647923%
  Fetal monitoring9528298773−16%
  Blood transfusion1473321329119%
45–64 years, total stays6,4969,6291,1551,2135%
  Blood transfusion2477884499126%
  Diagnostic cardiac catheterization, coronary arteriography57863810380−22%
  Respiratory intubation and mechanical ventilation186443335669%
  Upper gastrointestinal endoscopy27540449514%
  Hemodialysis154328274151%
65–84 years, total stays10,12110,4683,3193,0847%
  Blood transfusion5141,245169367118%
  Diagnostic cardiac catheterization, coronary arteriography738664242196−19%
  Respiratory intubation and mechanical ventilation36654312016033%
  Upper gastrointestinal endoscopy530494174145−16%
  Knee arthroplasty2013666610863%
85+ years, total stays2,3623,0766,0475,46310%
  Blood transfusion13837535366789%
  Upper gastrointestinal endoscopy122134313238−24%
  Respiratory intubation and mechanical ventilation6512116821528%
  Echocardiogram6586165154−7%
  Treatment, fracture or dislocation of hip and femur8786222153−31%

Includes a small number of stays (51,500 or 0.1 percent) with missing age.

2009 stays per 10,000 population are not statistically different from 1997 stays per 10,000 population at p<0.05.

Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997 and 2009.

While some of the most frequent procedures varied by age group, some were common across several age groups.

  • Blood transfusion was a top five procedure in all age groups except infants less than 1 year old. It was the third most common procedure for 1–17 year olds and the first for adults 45–64, 65–84, and 85 years and older. Blood transfusion was one of the fastest growing procedures from 1997 to 2009, more than doubling for patients 18–44, 45–64, and 65–84.
  • Respiratory intubation and mechanical ventilation was common for all age groups except 18 to 44 year olds. The rate of respiratory intubation and mechanical ventilation grew rapidly from 1997 to 2009 among 45–64 year olds (69 percent), 65–84 year olds (33 percent), and seniors 85 years and older (28 percent).
  • Diagnostic cardiac catheterization and coronary arteriography was common for 45–64 year olds (638,000 procedures) and 65–84 year olds (664,000 procedures), but the rate of procedures declined about 20 percent from 1997 to 2009 in both age groups.

For infants:

  • The most common procedures performed on infants were routine procedures, such as vaccinations (performed in 3,556 stays per 10,000 infants) and circumcision (performed in 2,746 stays per 10,000 infants).
    • In 2009, 1.2 million circumcisions were completed in the hospital (55 percent of male liveborn infants).
  • Procedures on infants also included those done for complex conditions affecting severely ill babies, such as respiratory intubation and mechanical ventilation (414 stays per 10,000 infants), enteral/parenteral nutrition (287 stays per 10,000 infants), and diagnostic spinal tap (199 stays per 10,000 infants).
    • The rate of enteral and parenteral nutrition, or tube feeding, during infant hospitalizations increased 176 percent whereas the rate of spinal tap procedures decreased 49 percent.

For children 1–17:

  • Appendectomy was the most common procedure for 1–17 year olds, performed in 12 stays per 10,000 population in this age group.
  • Other top procedures common in stays for children included repair of obstetric laceration in teen deliveries, blood transfusion, cancer chemotherapy, and respiratory intubation and mechanical ventilation.

For adults 18–44:

  • Four of the top five most common procedures were related to pregnancy and childbirth for adults 18–44 years old.
    • Cesarean sections and repair of obstetric laceration were the most frequently performed procedures, performed in 119 and 114 stays per 10,000 population among this age group in 2009.
    • The rate of Cesarean sections increased by 69 percent from 1997 to 2009.
    • The rate of stays with artificial rupture of membranes to assist delivery also experienced rapid growth from 1997 to 2009 (up 23 percent), while the rate of fetal monitoring procedures remained relatively stable.
  • Blood transfusion was the fifth most frequent procedure among adults 18–44 years old, and the rate of this procedure more than doubled from 1997 to 2009 (from 13 to 29 stays per 10,000 population).

For adults 45–64 and 65–84:

  • In 2009, the top four most frequently performed procedures were the same for individuals 45–64 and 65–84 years old: blood transfusion, diagnostic cardiac catheterization and coronary arteriography, respiratory intubation and mechanical ventilation, and upper gastrointestinal endoscopy.
    • Blood transfusion was the leading procedure for 45–64 year olds and 65–84 year olds, and the rate of stays with this procedure more than doubled in both age groups from 1997 to 2009.
    • Diagnostic cardiac catheterization and coronary arteriography was the second most common procedure performed in each of these age groups.
  • Hemodialysis was a top procedure among individuals 45–64, and the rate of stays with this procedure increased by about 50 percent from 1997 to 2009 (from 27 to 41 stays per 10,000 population).
  • Knee replacement was a top procedure among individuals 65–84, and the rate of stays with this procedure increased by 63 percent from 1997 to 2009 (from 66 to 108 stays per 10,000 population).

For adults 85 years and older:

  • For patients 85 years and older, blood transfusion was the most common procedure, occurring in 667 stays per 10,000 population.
  • Echocardiogram was the fourth most frequent procedure for patients 85 years and older (86,000 stays), and the rate of stays with this procedure remained relatively stable from 1997 to 2009 (7 percent decline).
  • Treatment of a fracture or dislocation of the hip and femur was a frequent procedure performed during a hospital stay and appeared only in this age group.
    • The rate of stays for treatment of a hip fracture or dislocation declined (31 percent) from 1997 to 2009, accounting for 86,000 stays in 2009.

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