Trends in Outpatient Treatment of Vascular Diseases

Recent trends for increase in inpatient vascular surgery (IP) are well documented. In this study we review utilization and procedural shifts for outpatient vascular procedures (OP) for which there are little data. The National Survey of Ambulatory Surgery database was used to determine nationwide rates of OP for years 1994-1996, and 2006; the National Inpatient Sample was used for IP. States CA, FL, NY and MD provided both IP and OP data, and were used as a representative sample of the nation for 2006-2009. CPT and ICD9 codes were divided into procedure groups and used to query the databases. Trends were analyzed using interrupted time series. Between 1994 and 2009 the rate of OP increased 250%, from 93.3 to 326.9 per 100,000 capita. Aging population accounted for 39% of the increase. Growth in OP outpaced IP, accounting for 15.8% of all interventions in 1994 and 32.3% in 2009. Patients 65 years and older had the greatest increase, and men had higher rates than women. Of the procedure groups, revascularization, imaging and arteriovenous access had the largest percent increase; rates of venous , skin graft and minor amputation procedures were stable (Table).TableTrends in the utilization of specific outpatient surgery groupsNSAS No data post-2006Combined statesPercent changeProcedures per 100000Procedures per 1000001994200620062009Revascularization7.7536.2838.7950.06545.58%AV access11.1144.4846.8552.97376.78%Imaging26.7386.4475.8891.50242.37%Venous procedures17.9932.4626.6426.3246.29%Minor amputation2.857.143.403.6327.18%Skin graft2.903.672.522.80-3.68% Open table in a new tab Vascular surgeries are increasingly performed as outpatient operations, both in absolute number and as a percent of the total. Possible causes include an increase in the prevalence of relevant risk factors, newer technologies, proliferation of freestanding surgical units and reimbursement policies.