STATISTICAL BRIEF #188

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1 HEALTHCARE COST AND UTILIZATION PROJECT STATISTICAL BRIEF #188 Agency for Helthcre Reserch nd Qulity Februry 2015 Surgeries in Hospitl-Owned Outptient Fcilities, 2012 Luren M. Wier, M.P.H., Cludi A. Steiner, M.D., M.P.H., nd Pmel L. Owens, Ph.D. Introduction From 1992 to 2012, the totl number of surgeries t community hospitls in the United Sttes incresed by 17 percent to bout 26.8 million surgeries. Outptient surgeries represented growing shre (65 percent; 17.3 million) of ll surgeries t community hospitls in the United Sttes in 2012, up from 54 percent (12.3 million) in surgery (AS), or outptient surgery, is plnned opertion for which the ptient is not expected to be dmitted to the hospitl. Comprison of mbultory surgery with inptient surgery is essentil for understnding utiliztion ptterns for specific surgicl procedures. This Helthcre Cost nd Utiliztion Project (HCUP) Sttisticl Brief compres surgeries performed t hospitl-owned fcilities in the mbultory (outptient) versus inptient in 28 Sttes tht provide dt for both types of s. These 28 Sttes represent bout two-thirds of the U.S. popultion. Procedures performed in freestnding (nonhospitl-owned) AS centers were not included becuse mny Stte AS dt sources do not include these types of centers. The nlysis ws limited to visits for dults ged 18 yers nd older who hd n invsive surgery commonly performed for therpeutic purposes (i.e., to tret disese or injury); excluded were noninvsive surgeries nd surgeries typiclly used for dignostic or explortory purposes (e.g., colonoscopy). The HCUP Surgery Flg softwre 2 ws used to identify invsive, therpeutic surgeries bsed on nrrow, trgeted, nd restrictive definition tht includes surgicl procedures tht involve incision, excision, mnipultion, or suturing of tissue tht penetrtes or breks the skin; typiclly require use of n 1 Americn Hospitl Assocition. Utiliztion nd volume. In: Trends Affecting Hospitls nd Helth Systems, chpter 3. Accessed August 13, Agency for Helthcre Reserch nd Qulity. HCUP Surgery Flg Softwre. Helthcre Cost nd Utiliztion Project (HCUP). Rockville, MD: Agency for Helthcre Reserch nd Qulity. Updted My Accessed August 13, Highlights In 2012 cross 28 sttes, 14.4 million hospitl visits involved invsive, therpeutic surgeries. Just over hlf of these visits (53.1 percent) were performed in hospitl-owned mbultory surgery (AS), nd the remining (46.9 percent) were inptient. Nerly ll hospitl-bsed surgicl procedures relted to the eye (98.8 percent) nd er (91.8 percent) were outptient. In contrst, obstetricl procedures were nerly ll inptient (97.7 percent). The following procedures were mong the most common mbultory surgeries: Lens nd ctrct procedures (99.9 percent performed in mbultory s [AS]) Cholecystectomy/common duct explortion (55.1 percent AS) Excision of semilunr crtilge of knee (98.5 percent AS) Herni repir (90.2 percent AS) Lumpectomy (96.5 percent AS) Decompression peripherl nerve (95.2 percent AS) Trnsurethrl excision; dringe; or removl urinry obstruction (71.9 percent AS) Pcemker/crdioverter (64.0 percent AS) Skin grft (67.0 percent AS) Hysterectomy (39.8 percent AS) Lminectomy/excision intervertebrl disc (26.1 percent AS) 1

2 operting room; nd lso require regionl nesthesi, generl nesthesi, or sedtion to control pin. This report presents the distribution of outptient surgery compred with inptient surgicl procedures by body system, s well s the most common surgicl procedures performed in n outptient. In ddition, mbultory nd inptient volume nd procedure rtes re compred for ech procedure. Unless otherwise noted, volumes nd rtes re bsed on ll-listed procedure codes. Findings Chrcteristics of surgeries performed in hospitl-owned mbultory versus inptient s, 2012 Tble 1 presents chrcteristics of community hospitl visits for invsive, therpeutic surgeries performed in the AS (outptient) versus the hospitl inptient (dmitted to the hospitl) in 28 Sttes in Tble 1. Chrcteristics of hospitl visits or stys for surgery performed in mbultory nd inptient s in 28 Sttes, 2012 Chrcteristics Totl visits or stys for surgeries, n 7,655,600 6,762,300 Percentge of ll surgicl visits or stys Visits or stys per 100,000 popultion 4,186 3,697 Totl number of surgeries, n 9,322,200 9,730,300 Percentge of ll surgicl procedures Averge number of surgeries per visit or sty Averge length of sty, dys Visits or stys by type of community hospitl b (%) Lrge hospitls Metropolitn hospitls Teching hospitls Non-Federl government hospitls Privte not-for-profit hospitls Privte for-profit hospitls Bsed on Stte popultion estimtes from the U.S. Census Bureu. b Hospitl chrcteristics relted to bed size, loction, nd teching sttus re not mutully exclusive. Source: Agency for Helthcre Reserch nd Qulity (AHRQ), Center for Delivery, Orgniztion, nd Mrkets, Helthcre Cost nd Utiliztion Project (HCUP), Stte Surgery nd Services Dtbses (SASD) nd Stte Dtbses (SID), 2012, from 28 Sttes Bsed on dt from 28 Sttes in 2012, 14.4 million hospitl visits were for invsive, therpeutic surgery; more thn hlf of these visits occurred in the AS. A totl of 14.4 million hospitl visits during which t lest one surgery ws performed in 2012 cross the 28 Sttes were exmined for this report. Just over hlf of these visits (53.1 percent) occurred in hospitl-owned AS, nd the remining visits (46.9 percent) occurred in the hospitl inptient. These visits included more thn 19 million totl surgeries, nerly hlf of which (48.9 percent) were performed in n outptient. The verge number of surgeries performed per visit ws slightly higher in the inptient thn the outptient (1.4 vs. 1.2). The mjority of AS nd inptient surgeries were performed t lrge, metropolitn, privte notfor-profit hospitls. Most mbultory surgicl visits nd most hospitl inptient surgicl stys occurred in lrge, metropolitn, privte not-for-profit hospitls. However, compred with inptient surgeries, outptient surgeries were more likely to be performed in smller hospitls, outside metropolitn res, nd in nonteching s. 2

3 Comprison of surgeries by body system in hospitl-owned mbultory versus inptient s, 2012 Figure 1 shows the distribution of invsive, therpeutic surgeries by body system tht were performed in AS nd hospitl inptient s in Figure 1. versus inptient surgeries by body system, % Percentge 80% 60% 40% % % Body System Note: Body systems re bsed on Clinicl Clssifictions Softwre (CCS) nd Clinicl Clssifictions Softwre for Services nd Procedures. Source: Agency for Helthcre Reserch nd Qulity (AHRQ), Center for Delivery, Orgniztion, nd Mrkets, Helthcre Cost nd Utiliztion Project (HCUP), Stte Surgery nd Services Dtbses (SASD) nd Stte Dtbses (SID), 2012, from 28 Sttes The mjority of surgeries on the eye, er, nose/mouth/phrynx, nd skin were performed in n outptient. Nerly ll invsive, therpeutic surgeries performed on the eye occurred in the AS (98.8 percent). The outptient lso ws most common for the mjority of surgeries performed on the er (91.8 percent), nose/mouth/phrynx (86.7 percent), nd skin (76.1 percent). The mjority of obstetricl, respirtory, nd crdiovsculr surgeries were performed in the inptient. Compred with the inptient, very few obstetricl surgeries were performed in the AS (2.3 vs percent). Similrly, respirtory (13.1 percent) nd crdiovsculr (28.3 percent) surgeries were less frequently performed in n mbultory. The most common mbultory surgeries performed, 2012 Tble 2 lists the 25 most common, invsive, therpeutic cliniclly grouped surgeries tht were performed in the AS in 2012, long with the percentge of these types of surgeries tht were performed in the outptient versus inptient. Surgeries re rnked from most to lest common in the AS. A comprehensive list of the distribution between the outptient nd inptient s for ll specific, invsive, therpeutic surgeries is presented in the ppendix. 3

4 Tble 2. The 25 most common mbultory surgeries performed in community hospitls, 2012 Number of surgeries, thousnds All-listed CCS procedures All mbultory surgeries, % Number of surgeries per 100,000 popultion Surgeries performed in n mbultory, % Lens nd ctrct procedures Other therpeutic procedures on muscles nd tendons Other OR therpeutic procedures on joints Cholecystectomy nd common duct explortion Excision of semilunr crtilge of knee Inguinl nd femorl herni repir Other OR therpeutic procedures on skin nd brest Lumpectomy; qudrntectomy of brest Decompression peripherl nerve Other herni repir Other OR therpeutic procedures on nose; mouth nd phrynx Other OR procedures on vessels other thn hed nd neck Other excision of cervix nd uterus Prtil excision bone Other OR therpeutic procedures on bone Trnsurethrl excision; dringe; or removl urinry obstruction Excision of skin lesion Other OR therpeutic procedures; femle orgns Insertion; revision; replcement; removl of crdic pcemker or crdioverter/defibrilltor Skin grft Hysterectomy; bdominl nd vginl Other introculr therpeutic procedures Debridement of wound; infection or burn Bunionectomy or repir of toe deformities Lminectomy; excision intervertebrl disc Abbrevition: OR, operting room. Bsed on Stte popultion estimtes from the U.S. Census Bureu. Note: Clinicl Clssifictions Softwre (CCS) nd Clinicl Clssifictions Softwre for Services nd Procedures. Source: Agency for Helthcre Reserch nd Qulity (AHRQ), Center for Delivery, Orgniztion, nd Mrkets, Helthcre Cost nd Utiliztion Project (HCUP), Stte Surgery nd Services Dtbses (SASD) nd Stte Dtbses (SID), 2012, from 28 Sttes 4

5 Lens nd ctrct procedures were the most common invsive, therpeutic type of surgery performed in n outptient. Lens nd ctrct procedures were the most common type of surgery performed in the AS, ccounting for 9.3 percent of ll AS surgeries performed. Nerly ll lens nd ctrct procedures (99.9 percent) were performed in n outptient. Most other introculr therpeutic procedures (mostly retinl procedures) lso were performed in the outptient (98.1 percent). Other therpeutic procedures on muscles/tendons nd joints were the second nd third most common types of outptient surgery. Other therpeutic procedures on muscles or tendons (mostly rottor cuff repir surgeries nd tendon sheth repir procedures) were the second most common type of surgery performed in the AS, ccounting for 5.8 percent of ll outptient surgeries. Other therpeutic procedures on joints (mostly knee nd shoulder rthroscopies) were rnked third, ccounting for 4.5 percent of ll outptient surgeries. The mjority of both types of procedures were performed in the outptient (72.4 nd 79.7 percent, respectively). Four other musculoskeletl system procedures were lso commonly performed in the outptient : excision of semilunr crtilge of knee (3.6 percent), prtil excision bone (2.0 percent), other operting room (OR) therpeutic procedures on bone (primrily removl of metl implnt; 1.9 percent), nd bunionectomy or repir of toe deformities (1.4 percent). Opertions on the digestive system ccounted for 3 of the 25 most common mbultory surgery procedures nd constituted 9.1 percent of ll outptient mbultory surgeries Opertions on the digestive system ccounted for 3 of the 25 most common types of AS surgery nd constituted 9.1 percent of ll outptient mbultory surgeries: cholecystectomy nd common duct explortion (4.0 percent), inguinl nd femorl herni repir (2.8 percent), nd other herni repir (2.3 percent). Approximtely 55 percent of ll cholecystectomy nd other herni repir surgeries nd over 90 percent of inguinl nd femorl herni repir surgeries were performed in the outptient. Five of the 25 most common outptient surgeries were procedures tht re primrily or exclusively performed on women. Five of the 25 most common outptient surgeries were procedures tht re primrily or exclusively performed on women: other OR therpeutic procedures on skin nd brest (primrily brest reduction or ugmenttion; 2.5 percent); lumpectomy, qudrntectomy of brest (2.4 percent); other excision of cervix nd uterus (predominntly uterine bltion; 2.2 percent); other OR therpeutic procedures, femle orgns (predominntly lproscopic removl of lesions; 1.7 percent); nd hysterectomy, bdominl nd vginl (1.7 percent). The mjority of these types of surgeries were performed in the outptient except for hysterectomy, which ws most commonly performed in the inptient (60.2 percent). 5

6 Appendix. Invsive, therpeutic surgeries, listed by body system, performed in community hospitls by (mbultory versus inptient), 2012 Number of surgeries Number of surgeries, thousnds per 100,000 popultion All-listed procedures (CCS number nd description) Opertions on the nervous system 6 Surgeries performed in n mbultory, % 3: Lminectomy; excision intervertebrl disc : Insertion of ctheter or spinl stimultor nd injection into spinl cnl : Decompression peripherl nerve : Other OR therpeutic nervous system procedures Opertions on the endocrine system 10: Thyroidectomy; prtil or complete : Other therpeutic endocrine procedures Opertions on the eye 13: Cornel trnsplnt : Glucom procedures : Lens nd ctrct procedures : Repir of retinl ter; detchment : Other therpeutic procedures on eyelids; conjunctiv; corne : Other introculr therpeutic procedures : Other extroculr muscle nd orbit therpeutic procedures Opertions on the er 22: Tympnoplsty : Myringotomy : Mstoidectomy : Other therpeutic er procedures Opertions on the nose, mouth, nd phrynx 27: Control of epistxis : Plstic procedures on nose : Dentl procedures : Tonsillectomy nd/or denoidectomy : Other OR therpeutic procedures on nose; mouth nd phrynx Opertions on the respirtory system 42: Other OR Rx procedures on respirtory system nd medistinum Opertions on the crdiovsculr system 45: Percutneous trnsluminl coronry ngioplsty (PTCA) : Insertion; revision; replcement; removl of crdic pcemker or crdioverter/defibrilltor 49: Other OR hert procedures : Vricose vein stripping; lower limb : Peripherl vsculr bypss

7 All-listed procedures (CCS number nd description) Number of surgeries, thousnds Number of surgeries per 100,000 popultion Surgeries performed in n mbultory, % 57: Cretion; revision nd removl of rteriovenous fistul or vessel-to-vessel cnnul for dilysis 59: Other OR procedures on vessels of hed nd neck : Other OR procedures on vessels other thn hed nd neck Opertions on the hemic nd lymphtic system 64: Bone mrrow trnsplnt : Other therpeutic procedures; hemic nd lymphtic system Opertions on the digestive system 78: Colorectl resection : Appendectomy : Hemorrhoid procedures : Cholecystectomy nd common duct explortion : Inguinl nd femorl herni repir : Other herni repir : Lproscopy (GI only) : Excision; lysis peritonel dhesions : Other OR upper GI therpeutic procedures : Other OR lower GI therpeutic procedures : Other OR gstrointestinl therpeutic procedures Opertions on the urinry system 100: Endoscopy nd endoscopic biopsy of the urinry trct : Trnsurethrl excision; dringe; or removl urinry obstruction : Nephrotomy nd nephrostomy : Genitourinry incontinence procedures : Indwelling ctheter : Procedures on the urethr : Other OR therpeutic procedures of urinry trct Opertions on the mle genitl system 113: Trnsurethrl resection of prostte (TURP) : Open prosttectomy : Circumcision : Other OR therpeutic procedures; mle genitl Opertions on the femle genitl system 119: Oophorectomy; unilterl nd bilterl : Other opertions on ovry : Ligtion or occlusion of fllopin tubes

8 All-listed procedures (CCS number nd description) Number of surgeries, thousnds Number of surgeries per 100,000 popultion 8 Surgeries performed in n mbultory, % 122: Removl of ectopic pregnncy : Other opertions on fllopin tubes : Hysterectomy; bdominl nd vginl : Other excision of cervix nd uterus : Abortion (termintion of pregnncy) : Dilttion nd curettge (D&C); spirtion fter delivery or bortion : Repir of cystocele nd rectocele; oblitertion of vginl vult : Other OR therpeutic procedures; femle orgns : Other therpeutic obstetricl procedures Opertions on the musculoskeletl system 142: Prtil excision bone : Bunionectomy or repir of toe deformities 144: Tretment; fcil frcture or disloction : Tretment; frcture or disloction of rdius nd uln : Tretment; frcture or disloction of hip nd femur : Tretment; frcture or disloction of lower extremity (other thn hip or femur) : Other frcture nd disloction procedure : Arthroscopy : Division of joint cpsule; ligment or crtilge : Excision of semilunr crtilge of knee : Arthroplsty knee : Hip replcement; totl nd prtil : Arthroplsty other thn hip or knee : Arthrocentesis : Amputtion of lower extremity : Spinl fusion : Other therpeutic procedures on muscles nd tendons : Other OR therpeutic procedures on bone : Other OR therpeutic procedures on joints : Other OR therpeutic procedures on musculoskeletl system Opertions on the integumentry system 166: Lumpectomy; qudrntectomy of brest : Mstectomy : Incision nd dringe; skin nd subcutneous tissue : Debridement of wound; infection or burn

9 All-listed procedures (CCS number nd description) Number of surgeries, thousnds Number of surgeries per 100,000 popultion Surgeries performed in n mbultory, % 170: Excision of skin lesion : Suture of skin nd subcutneous tissue : Skin grft : Other OR therpeutic procedures on skin nd brest Miscellneous dignostic nd therpeutic procedures 211: Therpeutic rdiology for cncer tretment : Other therpeutic procedures Abbrevition: CCS, Clinicl Clssifictions Softwre. Notes: Sttistics re bsed on the nrrow definition of the HCUP Surgery Flg softwre. CCS procedure ctegories with fewer thn 2,000 mbultory surgery cses re excluded. The top 25 surgicl procedures lso reported in Tble 2 re highlighted. Source: Agency for Helthcre Reserch nd Qulity (AHRQ), Center for Delivery, Orgniztion, nd Mrkets, Helthcre Cost nd Utiliztion Project (HCUP), Stte Surgery nd Services Dtbses (SASD) nd Stte Dtbses (SID), 2012, from 28 Sttes 9

10 Dt Source The volumes nd rtes in this Sttisticl Brief re bsed upon dt from the Helthcre Cost nd Utiliztion Project (HCUP) 2012 Stte Surgery nd Services Dtbses (SASD) nd 2012 Stte Dtbses (SID). This report evlutes both outptient nd inptient surgery dt from 28 Sttes tht contributed dt to both the 2012 SASD nd the 2012 SID: Cliforni, Colordo, Connecticut, Florid, Georgi, Illinois, Indin, Iow, Knss, Kentucky, Mrylnd, Michign, Minnesot, Missouri, Nebrsk, Nevd, New Jersey, New York, North Crolin, Ohio, Oklhom, Oregon, South Crolin, South Dkot, Tennessee, Texs, Vermont, nd Wisconsin. Supplementl sources included popultion denomintor dt for use with HCUP dtbses, derived from informtion vilble from the Bureu of the Census. 3 Definitions Procedures, ICD-9-CM, Current Procedurl Terminology (CPT ), nd Clinicl Clssifictions Softwre (CCS) All-listed procedures include ll procedures performed during the hospitl inptient sty or outptient visit, whether for definitive tretment or for dignostic or explortory purposes. Procedures re deduplicted: if prticulr CCS procedure occurs multiple times during the sme surgicl visit or hospitl sty, it is counted only once. Procedures on inptient hospitliztion records re coded using the Interntionl Clssifiction of Diseses, Ninth Revision, Clinicl Modifiction (ICD-9-CM); procedures on mbultory surgery nd services records cn be coded using either ICD-9-CM or the CPT. ICD-9-CM nd CPT both ssign numeric codes to procedures; ICD-9-CM is limited to procedures in the inptient. There re pproximtely 4,000 ICD-9-CM procedure codes nd 9,600 CPT procedure codes. CCS ctegorizes ICD-9-CM procedure codes into mngeble number of cliniclly meningful, mutully exclusive ctegories. 4 This clinicl grouper mkes it esier to quickly understnd ptterns of procedure use. When CPT ws used on mbultory surgery records, the CCS for Services nd Procedures 5 ws used to clssify procedures into groupings comprble to the CCS. Cse definition For this report, records from the SASD meeting the following criteri were included: The dischrge originted from hospitl-owned fcility with t lest 200 mbultory surgery visits per yer. The mbultory surgery is designted s short-term, community, nonrehbilittion hospitl. surgeries from nonhospitl-owned fcilities were not included. Ptients were ged 18 yers nd older. Length of sty ws 0 or 1 dy. The HCUP Surgery Flg softwre 6 ws used to identify procedures tht re clssified s surgery bsed on nrrow definition (surgery flg vlue = NARROW). 7 Records with one or 3 Brrett M, Lopez-Gonzlez L, Coffey R, Levit K. Popultion Denomintor Dt for Use with the HCUP Dtbses (Updted with 2013 Popultion Dt). HCUP Methods Series Report # August 18, U.S. Agency for Helthcre Reserch nd Qulity. Accessed September 11, Agency for Helthcre Reserch nd Qulity. HCUP Clinicl Clssifictions Softwre (CCS). Helthcre Cost nd Utiliztion Project (HCUP). Rockville, MD: Agency for Helthcre Reserch nd Qulity. Updted July Accessed August 13, Agency for Helthcre Reserch nd Qulity. HCUP Clinicl Clssifictions Softwre for Services nd Procedures. Helthcre Cost nd Utiliztion Project (HCUP). Rockville, MD: Agency for Helthcre Reserch nd Qulity. Updted My Accessed August 13, Agency for Helthcre Reserch nd Qulity. HCUP Surgery Flg Softwre. Helthcre Cost nd Utiliztion Project (HCUP). Rockville, MD: Agency for Helthcre Reserch nd Qulity. Updted My Accessed August 13, An invsive therpeutic surgicl procedure involving incision, excision, mnipultion, or suturing of tissue tht penetrtes or breks the skin; typiclly requires use of n operting room; nd lso requires regionl nesthesi, generl nesthesi, or sedtion to control pin. Guiding key terms include invsive (does not go through n existing orifice); therpeutic; pcemkers; robotic-ssisted 10

11 more nrrow surgery procedures were retined. All procedures tht did not meet the nrrow surgery definition were dropped from the record. The procedure ws included when t lest 2,000 mbultory surgery cses occurred cross the 28 Sttes in 2012, becuse the focus of this nlysis ws on the most frequent procedures done in the mbultory. In this report, records from the SID meeting the following criteri were included: The dischrge originted from hospitl with t lest 200 inptient surgicl stys. The inptient fcility is designted s short-term, community, nonrehbilittion hospitl. Ptients were ged 18 yers nd older. The HCUP Surgery Flg softwre ws used to identify procedures tht re clssified s surgery bsed on nrrow definition (surgery flg vlue = NARROW). Records with one or more nrrow surgery flgs were retined. All procedures tht did not meet the nrrow surgery definition were dropped from the record. The procedure met the criteri for including procedures from the SASD (i.e., included when t lest 2,000 mbultory surgery cses occurred cross the 28 Sttes in 2012, becuse the focus of this nlysis ws on the most frequent procedures done in the mbultory ). Types of hospitls included in HCUP Stte Dtbses This nlysis used Stte Dtbses (SID) limited to dt from community hospitls, which re defined s short-term, non-federl, generl, nd other hospitls, excluding hospitl units of other institutions (e.g., prisons). Community hospitls include obstetrics nd gynecology, otolryngology, orthopedic, cncer, peditric, public, nd cdemic medicl hospitls. Excluded for this nlysis re long-term cre fcilities such s rehbilittion, psychitric, nd lcoholism nd chemicl dependency hospitls. However, if ptient received long-term cre, rehbilittion, or tretment for psychitric or chemicl dependency conditions in community hospitl, the dischrge record for tht sty ws included in the nlysis. We limited the nlysis to hospitls with t lest 200 inptient surgicl stys per yer. Types of hospitls included in HCUP Stte Surgery nd Services Dtbses This nlysis used Stte Surgery nd Services Dtbses (SASD) limited to dt from hospitl-owned mbultory surgery fcilities. Although some SASD include dt from fcilities not owned by hospitl, those fcilities were excluded from this nlysis. The designtion of fcility s hospitlowned is specific to its finncil reltionship with hospitl tht provides inptient cre nd is not relted to its physicl loction. surgery performed in hospitl-owned fcilities my be performed within the hospitl, in fcility ttched to the hospitl, or in fcility physiclly seprted from the hospitl. The nlysis ws further limited to mbultory surgeries performed t fcilities owned by community hospitls. Community hospitls re defined s short-term, non-federl, generl, nd other specilty hospitls, excluding hospitl units of other institutions (e.g., prisons). We limited the nlysis to community hospitls with t lest 200 mbultory surgery visits per yer. Unit of nlysis The unit of nlysis is the mbultory surgery visit or hospitl dischrge (i.e., the hospitl sty), not person or ptient. For this report, ny reference to visit or hospitl sty indictes tht the unit of nlysis is the record, rther thn the surgicl procedure. Any reference to surgeries indictes tht the unit of nlysis is procedure. About HCUP The Helthcre Cost nd Utiliztion Project (HCUP, pronounced "H-Cup") is fmily of helth cre dtbses nd relted softwre tools nd products developed through Federl-Stte-Industry prtnership nd sponsored by the Agency for Helthcre Reserch nd Qulity (AHRQ). HCUP dtbses bring together the dt collection efforts of Stte dt orgniztions, hospitl ssocitions, nd privte dt orgniztions (HCUP Prtners), nd the Federl government to crete ntionl informtion resource of encounter-level helth cre dt. HCUP includes the lrgest collection of longitudinl hospitl cre dt in the United Sttes, with ll-pyer, encounter-level informtion beginning in These procedures; lproscopy; lyer closure; complex repir; extensive, complicted; penetrting wound; deep; complicted; nd tissue trnsfer. 11

12 dtbses enble reserch on brod rnge of helth policy issues, including cost nd qulity of helth services, medicl prctice ptterns, ccess to helth cre progrms, nd outcomes of tretments t the ntionl, Stte, nd locl mrket levels. HCUP would not be possible without the contributions of the following dt collection Prtners from cross the United Sttes: Alsk Stte Hospitl nd Nursing Home Assocition Arizon Deprtment of Helth Services Arknss Deprtment of Helth Cliforni Office of Sttewide Helth Plnning nd Development Colordo Hospitl Assocition Connecticut Hospitl Assocition Florid Agency for Helth Cre Administrtion Georgi Hospitl Assocition Hwii Helth Informtion Corportion Illinois Deprtment of Public Helth Indin Hospitl Assocition Iow Hospitl Assocition Knss Hospitl Assocition Kentucky Cbinet for Helth nd Fmily Services Louisin Deprtment of Helth nd Hospitls Mine Helth Dt Orgniztion Mrylnd Helth Services Cost Review Commission Msschusetts Center for Helth Informtion nd Anlysis Michign Helth & Hospitl Assocition Minnesot Hospitl Assocition Mississippi Deprtment of Helth Missouri Hospitl Industry Dt Institute Montn MHA - An Assocition of Montn Helth Cre Providers Nebrsk Hospitl Assocition Nevd Deprtment of Helth nd Humn Services New Hmpshire Deprtment of Helth & Humn Services New Jersey Deprtment of Helth New Mexico Deprtment of Helth New York Stte Deprtment of Helth North Crolin Deprtment of Helth nd Humn Services North Dkot (dt provided by the Minnesot Hospitl Assocition) Ohio Hospitl Assocition Oklhom Stte Deprtment of Helth Oregon Assocition of Hospitls nd Helth Systems Oregon Helth Policy nd Reserch Pennsylvni Helth Cre Cost Continment Council Rhode Islnd Deprtment of Helth South Crolin Revenue nd Fiscl Affirs Office South Dkot Assocition of Helthcre Orgniztions Tennessee Hospitl Assocition Texs Deprtment of Stte Helth Services Uth Deprtment of Helth Vermont Assocition of Hospitls nd Helth Systems Virgini Helth Informtion Wshington Stte Deprtment of Helth West Virgini Helth Cre Authority Wisconsin Deprtment of Helth Services Wyoming Hospitl Assocition 12

13 About Sttisticl Briefs HCUP Sttisticl Briefs re descriptive summry reports presenting sttistics on hospitl inptient nd emergency deprtment use nd costs, qulity of cre, ccess to cre, medicl conditions, procedures, ptient popultions, nd other topics. The reports use HCUP dministrtive helth cre dt. About the SASD The HCUP Stte Surgery nd Services Dtbses (SASD) include encounter-level dt for mbultory surgeries nd my lso include vrious types of outptient services such s observtion stys, lithotripsy, rdition therpy, imging, chemotherpy, nd lbor nd delivery. The specific types of mbultory surgery nd outptient services included in ech SASD vry by Stte nd dt yer. All SASD include dt from hospitl-owned mbultory surgery fcilities. In ddition, some Sttes include dt from fcilities not owned by hospitl. The designtion of fcility s hospitl-owned is specific to its finncil reltionship with hospitl tht provides inptient cre nd is not relted to its physicl loction. Hospitl-owned mbultory surgery nd other outptient cre fcilities my be contined within the hospitl, physiclly ttched to the hospitl, or locted in different geogrphic re. In order to provide informtion tht is comprble cross ll Sttes, nlysis ws restricted to hospitl-owned mbultory surgery. About the SID The HCUP Stte Dtbses (SID) re hospitl inptient dtbses from dt orgniztions prticipting in HCUP. The SID contin the universe of the inptient dischrge bstrcts in the prticipting HCUP Sttes, trnslted into uniform formt to fcilitte multistte comprisons nd nlyses. Together, the SID encompss more thn 95 percent of ll U.S. community hospitl dischrges in The SID cn be used to investigte questions unique to one Stte, to compre dt from two or more Sttes, to conduct mrket-re vrition nlyses, nd to identify Stte-specific trends in inptient cre utiliztion, ccess, chrges, nd outcomes. For More Informtion For more informtion bout HCUP, visit For dditionl HCUP sttistics, visit HCUPnet, our interctive query system, t For informtion on other hospitliztions in the United Sttes, refer to the following HCUP Sttisticl Briefs locted t Sttisticl Brief #180, Overview of Hospitl Stys in the United Sttes, 2012 Sttisticl Brief #181, Costs for Hospitl Stys in the United Sttes, 2012 Sttisticl Brief #186, Most Frequent Operting Room Procedures Performed in U.S. Hospitls, Sttisticl Brief #162, Most Frequent Conditions in U.S. Hospitls, 2011 For detiled description of HCUP nd more informtion on the design of the Stte Surgery nd Services Dtbses (SASD) nd Stte Dtbses (SID), plese refer to the following dtbse documenttion: Agency for Helthcre Reserch nd Qulity. Overview of the Stte Surgery nd Services Dtbses (SASD). Helthcre Cost nd Utiliztion Project (HCUP). Rockville, MD: Agency for Helthcre Reserch nd Qulity. Updted November Accessed December 15, Agency for Helthcre Reserch nd Qulity. Overview of the Stte Dtbses (SID). Helthcre Cost nd Utiliztion Project (HCUP). Rockville, MD: Agency for Helthcre Reserch nd 13

14 Qulity. Updted September Accessed September 11, Suggested Cittion Wier LM (Truven Helth Anlytics), Steiner CA (AHRQ), Owens PL (AHRQ). Surgeries in Hospitl-Owned Outptient Fcilities, HCUP Sttisticl Brief #188. Februry Agency for Helthcre Reserch nd Qulity, Rockville, MD. Outptient-Fcilities-2012.pdf. Acknowledgments The uthors would like to cknowledge the contributions of Nils Nordstrnd of Truven Helth Anlytics. AHRQ welcomes questions nd comments from reders of this publiction who re interested in obtining more informtion bout ccess, cost, use, finncing, nd qulity of helth cre in the United Sttes. We lso invite you to tell us how you re using this Sttisticl Brief nd other HCUP dt nd tools, nd to shre suggestions on how HCUP products might be enhnced to further meet your needs. Plese e-mil us t hcup@hrq.gov or send letter to the ddress below: Irene Frser, Ph.D., Director Center for Delivery, Orgniztion, nd Mrkets Agency for Helthcre Reserch nd Qulity 540 Gither Rod Rockville, MD