Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010

February 28, 2017

Questions for Margaret J. Hall, Health Statistician and Lead Author of “Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010.”

Q: Why did you decide to do a report on national estimates of surgical and nonsurgical ambulatory procedures performed in hospitals and ambulatory surgery centers?

MH: The National Center for Health Statistics (NCHS), Division of Health Care Statistics, gathers national data on health care utilization. Included are surveys of inpatient care, physicians’ office care, and emergency department and outpatient department care. From 1994 to 1996, and again in 2006, NCHS gathered ambulatory surgery data through the National Survey of Ambulatory Surgery. Ambulatory surgery, also called outpatient surgery, refers to surgical and nonsurgical procedures that are nonemergency, scheduled in advance, and generally do not result in an overnight hospital stay. The nationally representative data from our inpatient and ambulatory surgery surveys showed that ambulatory surgery procedures made up a large part of the total surgery performed in the United States. In 2010, we were able to expand the National Hospital Ambulatory Medical Care Survey (NHAMCS), which has gathered data on hospital emergency and outpatient department utilization since 1992, to also gather data on ambulatory surgery in hospitals and in ambulatory surgery centers. This meant that we could provide more recent estimates of this important component of health care utilization.

Data were gathered on patient characteristics including age, sex, expected payment source, duration of surgery, and discharge disposition, as well as on the number and types of procedures performed in these settings. As is the case in our other health care surveys, sample data are collected and are then weighted to produce nationally representative estimates.


Q: Is the first time NCHS has published a report on this topic? Is there trend data?

MH: NCHS has published ambulatory surgery data for 1994 through 1996 and again for 2006. This report primarily contains 2010 data but it does note that the estimated number of ambulatory surgery visits decreased from 34.7 million to 28.6 million from 2006 to 2010. This 18% drop was statistically significant. But the 48.3 million ambulatory surgery procedures estimated using 2010 NHAMCS data was not significantly different from the 53.3 million ambulatory surgery procedures estimated using 2006 NSAS data.


Q: How do ambulatory surgery procedures by sex and age break down?

MH: For both males and females, 39% of procedures were performed on those aged 45–64. For females, about 24% of procedures were performed on those aged 15–44 compared with 18% for males, whereas the percentage of procedures performed on those under 15 was lower for females than for males (4% compared with 9%). About 19% of procedures were performed on those aged 65–74, with about 14% performed on those aged 75 and over. For the latter two age groups, there was no significant difference between males and females.


Q: What types of ambulatory surgery procedures are most patients getting?

MH: Seventy percent of the 48.3 million ambulatory surgery procedures were in the following clinical categories: operations on the digestive system (10 million or 21%), operations on the eye (7.9 million or 16%), operations on the musculoskeletal system (7.1 million or 15%), operations on the integumentary system (4.3 million or 9%), and operations on the nervous system (4.2 million or 9%). These procedure categories made up 72% of procedures performed on females and 67% of those performed on males.

  • Examples of operations on the digestive system include endoscopy of large intestine—which included colonoscopies—which was performed 4.0 million times; endoscopy of small intestine which was performed 2.2 million times; and endoscopic polypectomy of large intestine which was performed an estimated 1.1 million times.
  • Eye operations included extraction of lens, performed 2.9 million times, and insertion of lens, performed 2.6 million times, both for cataracts; and operations on eyelids, performed 1.0 million times.
  • Musculoskeletal procedures included operations on muscle, tendon, fascia, and bursa, performed 1.3 million times.
  • Operations on the integumentary system included excision or destruction of lesion or tissue of skin and subcutaneous tissue, performed 1.2 million times.
  • Operations on the nervous system included injection of agent into spinal canal, performed 2.9 million times, including injections for pain relief.

Q: Were there any findings that surprised you?

MH: It was surprising that the number of ambulatory surgery visits and procedures performed did not increase from 2006 to 2010. Instead our 2010 data showed that there was a significant decrease of 18% in the number of ambulatory surgery visits since 2006. The number of procedures performed during 2010 did not differ significantly from the number performed in 2006.

One reason for these findings could be an under count in the survey in 2010. There were some problems in hospitals identifying in-scope ambulatory surgery visits since they were more dispersed throughout the hospitals in 2010 than they had been in 2006. Another reason that ambulatory surgery visit estimates could have decreased could be the deep economic recession that began in 2007. By 2010, when our survey began gathering ambulatory surgery data in both hospitals and Ambulatory Service Centers, the economy had not fully recovered and, due to this, some patients may have decided not to schedule ambulatory surgery. Some ambulatory surgery procedures are elective.


Emergency Department Visits Related to Schizophrenia Among Adults Aged 18–64: United States, 2009–2011

September 23, 2015

Schizophrenia is a severe brain disorder with clinical manifestations that may include hallucinations, delusions, and thought and movement disorders.

A new NCHS report describes the rate and characteristics of emergency department (ED) visits related to schizophrenia among adults aged 18–64.

Key Findings from the Report:

  • During 2009–2011, an estimated 382,000 ED visits related to schizophrenia occurred each year among adults aged 18–64, with an overall ED visit rate of 20.1 per 10,000 adults.
  • The overall rate for ED visits related to schizophrenia for men (26.5 per 10,000) was approximately double the rate for women (13.8 per 10,000).
  • Public insurance (Medicaid, Medicare, or dual Medicare and Medicaid) was used more frequently at ED visits related to schizophrenia compared with ED visits not related to schizophrenia.
  • About one-half of ED visits related to schizophrenia led to either a hospital admission (32.7%) or a transfer to a psychiatric hospital (16.7%); these percentages were higher than for ED visits not related to schizophrenia.

 


Progress With Electronic Health Record Adoption

February 19, 2015

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provides incentive payments to eligible hospitals and providers that demonstrate the meaningful use of a certified electronic health record (EHR) system.

A new report describes the adoption of EHRs in hospital emergency departments (EDs) and outpatient departments (OPDs) from 2006 through 2011 using the National Hospital Ambulatory Medical Care Survey.

Key Findings from the Report:

  • In 2011, 84% of hospital emergency departments used an electronic health record system.
  • Adoption of a basic EHR system with a specific set of functionalities by EDs increased from 19% in 2007 to 54% in 2011.
  • In 2011, 73% of hospital outpatient departments used an EHR system, up from 29% in 2006.
  • Adoption of a basic EHR system with a specific set of functionalities by OPDs increased from 9% in 2007 to 57% in 2011.
  • From 2007 through 2011, adoption of Stage 1 Meaningful Use objectives by EDs and OPDs increased.
  • In 2011, 14% of EDs and 16% of OPDs had EHR technology able to support nine Stage 1 Meaningful Use objectives.

Emergency Department Visits for Motor Vehicle Traffic Injuries: United States, 2010–2011

January 30, 2015

In spite of improvements in motor vehicle safety in recent years, motor vehicle crashes remain a major source of morbidity and mortality in the United States. Motor vehicle-related deaths and injuries also result in substantial economic and societal costs related to medical care and lost productivity.

A new NCHS report describes the rates and characteristics of emergency department (ED) visits for motor vehicle traffic injuries during 2010–2011 based on nationally representative data from the National Hospital Ambulatory Medical Care Survey.

Key Findings from the Report:

  • In 2010–2011, the emergency department (ED) visit rate for motor vehicle traffic injuries was highest among persons aged 16–24 years. The rates declined with age after 16–24, with rates for those aged 0–15 similar to those 65 and over.
  • The overall ED visit rate for motor vehicle traffic injuries was higher among non-Hispanic black persons compared with non-Hispanic white and Hispanic persons.
  • Imaging services were ordered or provided at 70.2% of ED visits for motor vehicle traffic injuries, which was higher than for other injury-related ED visits (55.9%).
  • About one-half of ED visits for motor vehicle traffic injuries had a primary diagnosis of sprains and strains of the neck and back, contusion with intact skin surface, or spinal disorders.

Rural Residents Who Are Hospitalized in Rural and Urban Hospitals: United States, 2010

July 18, 2014

In 2010, 17% of the U.S. population lived in rural (nonmetropolitan) areas. Many rural areas are medically underserved due to physician (especially specialist) shortages. Rural hospitals often are small, with a low volume of services, and have difficulty remaining financially viable under the regular hospital prospective payment system. Special Medicare hospital payment categories have been established so that rural residents have access to hospital care without traveling to urban areas. The share of rural residents’ hospitalizations that take place in urban (metropolitan) compared with rural hospitals has been of interest for a number of years. Those who go to urban hospitals have been described as “bypassing” rural hospitals.

A new NCHS report compares characteristics of rural residents who stay in rural areas with those who travel to urban areas for their inpatient care.

Key Findings from the Report:

  • Sixty percent of the 6.1 million rural residents who were hospitalized in 2010 went to rural hospitals; the remaining 40% went to urban hospitals.
  • Rural residents who remained in rural areas for their hospitalization were more likely to be older and on Medicare compared with those who went to urban areas.
  • Almost three-quarters of rural residents who traveled to urban areas received surgical or nonsurgical procedures during their hospitalization (74%), compared with only 38% of rural residents who were hospitalized in rural hospitals.
  • More than 80% of rural residents who were discharged from urban hospitals had routine discharges (81%), generally to their homes, compared with 63% of rural residents discharged from rural hospitals.

Physician Experience With Electronic Health Record Systems

September 18, 2013

A new report from NCHS looks at Electronic Health Record (EHR) systems that meet the meaningful use criteria have specific capabilities associated with efficient and high-quality patient care.  The criteria is set by the Centers for Medicare & Medicaid Services.

Key Findings from the Report:

  • About three-quarters of physicians with electronic health record systems have systems that meet meaningful use criteria.
  • Physicians with EHR systems that meet meaningful use criteria were more likely to report that their system provides time savings than physicians with systems not meeting meaningful use criteria, but only in some areas.
  • Physicians with EHR systems that meet meaningful use criteria were more likely to report enhanced confidentiality and less disruption in their interactions with patients than physicians with systems not meeting meaningful use criteria.
  • Physicians with EHR systems that meet meaningful use criteria were no more likely to report financial benefits and selected clinical benefits than those with systems not meeting meaningful use criteria.

A brief look at emergency room visits

November 19, 2008

In 2006, about 4 out of every 10 people visited an emergency room.

Of those visits–

About 22% were seen in less than 15 minutes.
About 13% needed hospital admission.
Only about 2% needed to transer to higher level or specialized care.

The most common diagnosis in emergency departments–injury and poisoning.

For more NCHS Fast Stats, please click here.