STATISTICAL BRIEF #188

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 1992. 1 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. http://www.h.org/reserch/reports/tw/chrtbook/index.shtml. Accessed August 13, 2014. 2 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 2013. http://www.hcupus.hrq.gov/toolssoftwre/surgflgs/surgeryflgs.jsp. Accessed August 13, 2014. 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

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 2012. 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 53.1 46.9 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 48.9 51.1 Averge number of surgeries per visit or sty 1.2 1.4 Averge length of sty, dys 0.1 5.4 Visits or stys by type of community hospitl b (%) Lrge hospitls 59.3 66.9 Metropolitn hospitls 86.8 92.4 Teching hospitls 48.8 55.7 Non-Federl government hospitls 11.9 11.7 Privte not-for-profit hospitls 74.3 73.3 Privte for-profit hospitls 13.8 15.0 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

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 2012. Figure 1. versus inptient surgeries by body system, 2012 100% 98.8 91.8 86.7 86.9 97.7 Percentge 80% 60% 40% 76.1 23.9 64.0 56.3 55.5 52.9 47.1 49.6 50.4 44.5 39.1 38.9 28.3 13.1 1.2 2.3 36.0 43.7 44.5 55.5 60.9 61.1 71.7 20% 8.2 13.3 0% 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. 97.7 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

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 9.3 865 1 473 0 99.9 Other therpeutic procedures on muscles nd tendons 5.8 543 207 297 113 72.4 Other OR therpeutic procedures on joints 4.5 420 107 229 58 79.7 Cholecystectomy nd common duct explortion 4.0 376 307 206 168 55.1 Excision of semilunr crtilge of knee 3.6 336 5 184 3 98.5 Inguinl nd femorl herni repir 2.8 260 28 142 15 90.2 Other OR therpeutic procedures on skin nd brest 2.5 231 73 126 40 75.9 Lumpectomy; qudrntectomy of brest 2.4 225 8 123 4 96.5 Decompression peripherl nerve 2.4 224 11 123 6 95.2 Other herni repir 2.3 218 180 119 98 54.8 Other OR therpeutic procedures on nose; mouth nd phrynx 2.2 205 47 112 26 81.2 Other OR procedures on vessels other thn hed nd neck 2.2 202 323 110 176 38.5 Other excision of cervix nd uterus 2.2 201 33 110 18 85.9 Prtil excision bone 2.0 190 245 104 134 43.7 Other OR therpeutic procedures on bone 1.9 180 96 98 52 65.3 Trnsurethrl excision; dringe; or removl urinry obstruction 1.9 173 68 95 37 71.9 Excision of skin lesion 1.7 160 7 88 4 96.1 Other OR therpeutic procedures; femle orgns 1.7 160 73 87 40 68.6 Insertion; revision; replcement; removl of crdic pcemker or 1.7 160 90 87 49 64.0 crdioverter/defibrilltor Skin grft 1.7 160 78 87 43 67.0 Hysterectomy; bdominl nd vginl 1.7 156 236 85 129 39.8 Other introculr therpeutic procedures 1.7 155 3 85 2 98.1 Debridement of wound; infection or burn 1.7 154 116 84 63 57.1 Bunionectomy or repir of toe deformities 1.4 134 3 74 1 98.1 Lminectomy; excision intervertebrl disc 1.3 122 345 67 189 26.1 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

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

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 122.2 345.5 66.8 188.9 26.1 5: Insertion of ctheter or spinl stimultor nd injection into spinl cnl 30.6 5.2 16.8 2.9 85.4 6: Decompression peripherl nerve 224.2 11.2 122.6 6.1 95.2 9: Other OR therpeutic nervous system procedures 90.2 126.7 49.3 69.3 41.6 Opertions on the endocrine system 10: Thyroidectomy; prtil or complete 55.0 33.7 30.1 18.4 62.0 12: Other therpeutic endocrine procedures 27.2 30.1 14.9 16.4 47.5 Opertions on the eye 13: Cornel trnsplnt 14.4 0.2 7.9 0.1 98.4 14: Glucom procedures 50.4 0.3 27.5 0.2 99.4 15: Lens nd ctrct procedures 864.9 0.7 472.8 0.4 99.9 16: Repir of retinl ter; detchment 37.9 0.7 20.7 0.4 98.2 19: Other therpeutic procedures on eyelids; conjunctiv; corne 106.8 5.7 58.4 3.1 95.0 20: Other introculr therpeutic procedures 155.2 3.0 84.9 1.7 98.1 21: Other extroculr muscle nd orbit therpeutic procedures 19.5 3.9 10.7 2.1 83.5 Opertions on the er 22: Tympnoplsty 17.6 0.5 9.6 0.3 97.0 23: Myringotomy 19.7 1.6 10.8 0.9 92.6 24: Mstoidectomy 9.8 1.5 5.3 0.8 86.8 26: Other therpeutic er procedures 26.3 2.9 14.4 1.6 89.9 Opertions on the nose, mouth, nd phrynx 27: Control of epistxis 17.6 1.2 9.6 0.7 93.6 28: Plstic procedures on nose 111.3 6.0 60.9 3.3 94.9 29: Dentl procedures 6.7 2.2 3.6 1.2 75.0 30: Tonsillectomy nd/or denoidectomy 65.1 5.4 35.6 2.9 92.4 33: Other OR therpeutic procedures on nose; mouth nd phrynx 204.8 47.4 112.0 25.9 81.2 Opertions on the respirtory system 42: Other OR Rx procedures on respirtory system nd medistinum 32.0 65.3 17.5 35.7 32.9 Opertions on the crdiovsculr system 45: Percutneous trnsluminl coronry ngioplsty (PTCA) 54.0 400.3 29.5 218.8 11.9 48: Insertion; revision; replcement; removl of crdic pcemker or 160.0 90.1 87.5 49.3 64.0 crdioverter/defibrilltor 49: Other OR hert procedures 24.4 141.1 13.3 77.2 14.7 53: Vricose vein stripping; lower limb 24.8 0.5 13.5 0.3 98.0 55: Peripherl vsculr bypss 3.0 49.3 1.7 26.9 5.8

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 95.0 35.9 51.9 19.6 72.6 cnnul for dilysis 59: Other OR procedures on vessels of hed nd neck 2.6 39.6 1.4 21.7 6.1 61: Other OR procedures on vessels other thn hed nd neck 202.0 322.7 110.5 176.4 38.5 Opertions on the hemic nd lymphtic system 64: Bone mrrow trnsplnt 3.0 11.5 1.7 6.3 20.9 67: Other therpeutic procedures; hemic nd lymphtic system 110.2 149.4 60.3 81.7 42.5 Opertions on the digestive system 78: Colorectl resection 5.2 224.2 2.8 122.6 2.3 80: Appendectomy 65.4 172.7 35.8 94.4 27.5 81: Hemorrhoid procedures 66.5 6.3 36.3 3.4 91.4 84: Cholecystectomy nd common duct explortion 376.0 307.0 205.6 167.8 55.1 85: Inguinl nd femorl herni repir 260.3 28.2 142.3 15.4 90.2 86: Other herni repir 218.5 180.1 119.4 98.5 54.8 87: Lproscopy (GI only) 15.0 0.0 8.2 0.0 99.9 90: Excision; lysis peritonel dhesions 29.5 252.3 16.1 137.9 10.5 94: Other OR upper GI therpeutic procedures 20.6 119.5 11.3 65.4 14.7 96: Other OR lower GI therpeutic procedures 80.8 188.2 44.2 102.9 30.0 99: Other OR gstrointestinl therpeutic procedures 40.8 166.6 22.3 91.1 19.7 Opertions on the urinry system 100: Endoscopy nd endoscopic biopsy of the urinry trct 9.0 0.0 4.9 0.0 100.0 101: Trnsurethrl excision; dringe; or removl urinry obstruction 172.9 67.6 94.5 37.0 71.9 103: Nephrotomy nd nephrostomy 8.1 37.9 4.4 20.7 17.6 106: Genitourinry incontinence procedures 74.2 35.2 40.6 19.2 67.8 108: Indwelling ctheter 25.9 8.7 14.2 4.8 74.8 109: Procedures on the urethr 32.7 7.4 17.9 4.0 81.6 112: Other OR therpeutic procedures of urinry trct 28.1 62.4 15.4 34.1 31.0 Opertions on the mle genitl system 113: Trnsurethrl resection of prostte (TURP) 42.5 31.6 23.2 17.3 57.3 114: Open prosttectomy 5.3 50.7 2.9 27.7 9.5 115: Circumcision 18.1 1.1 9.9 0.6 94.1 118: Other OR therpeutic procedures; mle genitl 99.0 15.7 54.1 8.6 86.3 Opertions on the femle genitl system 119: Oophorectomy; unilterl nd bilterl 98.0 169.4 53.6 92.6 36.7 120: Other opertions on ovry 43.1 33.4 23.6 18.3 56.3 121: Ligtion or occlusion of fllopin tubes 83.0 196.2 45.4 107.2 29.7 7

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 11.6 10.0 6.4 5.5 53.7 123: Other opertions on fllopin tubes 29.1 26.2 15.9 14.3 52.6 124: Hysterectomy; bdominl nd vginl 155.7 235.9 85.1 129.0 39.8 125: Other excision of cervix nd uterus 201.3 33.1 110.0 18.1 85.9 126: Abortion (termintion of pregnncy) 10.0 1.0 5.5 0.6 90.5 127: Dilttion nd curettge (D&C); spirtion fter delivery or bortion 110.7 25.0 60.5 13.7 81.6 129: Repir of cystocele nd rectocele; oblitertion of vginl vult 45.3 44.4 24.8 24.3 50.5 132: Other OR therpeutic procedures; femle orgns 160.0 73.3 87.5 40.1 68.6 141: Other therpeutic obstetricl procedures 12.1 5.2 6.6 2.9 69.8 Opertions on the musculoskeletl system 142: Prtil excision bone 190.3 245.4 104.0 134.1 43.7 143: Bunionectomy or repir of toe 134.4 2.6 73.5 1.4 98.1 deformities 144: Tretment; fcil frcture or disloction 37.5 17.7 20.5 9.7 68.0 145: Tretment; frcture or disloction of rdius nd uln 73.9 37.4 40.4 20.4 66.4 146: Tretment; frcture or disloction of hip nd femur 3.4 195.0 1.9 106.6 1.7 147: Tretment; frcture or disloction of lower extremity (other thn hip or femur) 89.7 130.5 49.1 71.4 40.7 148: Other frcture nd disloction procedure 112.3 106.6 61.4 58.3 51.3 149: Arthroscopy 53.7 1.6 29.4 0.9 97.2 150: Division of joint cpsule; ligment or crtilge 46.8 10.2 25.6 5.6 82.1 151: Excision of semilunr crtilge of knee 336.5 5.2 183.9 2.8 98.5 152: Arthroplsty knee 46.4 513.6 25.4 280.8 8.3 153: Hip replcement; totl nd prtil 7.9 345.9 4.3 189.1 2.2 154: Arthroplsty other thn hip or knee 100.8 66.2 55.1 36.2 60.4 155: Arthrocentesis 20.6 0.1 11.3 0.0 99.7 157: Amputtion of lower extremity 22.7 97.0 12.4 53.0 19.0 158: Spinl fusion 35.6 332.9 19.4 182.0 9.7 160: Other therpeutic procedures on muscles nd tendons 543.0 207.3 296.9 113.3 72.4 161: Other OR therpeutic procedures on bone 179.7 95.6 98.3 52.2 65.3 162: Other OR therpeutic procedures on joints 419.7 106.6 229.5 58.3 79.7 164: Other OR therpeutic procedures on musculoskeletl system 32.8 30.0 17.9 16.4 52.2 Opertions on the integumentry system 166: Lumpectomy; qudrntectomy of brest 224.9 8.1 123.0 4.4 96.5 167: Mstectomy 32.9 45.6 18.0 24.9 41.9 168: Incision nd dringe; skin nd subcutneous tissue 35.0 0.4 19.1 0.2 98.8 169: Debridement of wound; infection or burn 154.5 115.8 84.5 63.3 57.1

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 160.1 6.6 87.5 3.6 96.1 171: Suture of skin nd subcutneous tissue 32.1 0.8 17.6 0.5 97.5 172: Skin grft 159.6 78.5 87.3 42.9 67.0 175: Other OR therpeutic procedures on skin nd brest 231.0 73.3 126.3 40.1 75.9 Miscellneous dignostic nd therpeutic procedures 211: Therpeutic rdiology for cncer tretment 5.6 3.1 3.1 1.7 64.3 231: Other therpeutic procedures 48.5 125.9 26.5 68.8 27.8 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

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 #2014-02. August 18, 2014. U.S. Agency for Helthcre Reserch nd Qulity. https://www.hcup-us.hrq.gov/reports/methods/2014-02.pdf. Accessed September 11, 2014. 4 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 2014. http://www.hcupus.hrq.gov/toolssoftwre/ccs/ccs.jsp. Accessed August 13, 2014. 5 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 2014. www.hcupus.hrq.gov/toolssoftwre/ccs_svcsproc/ccssvcproc.jsp. Accessed August 13, 2014. 6 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 2013. http://www.hcupus.hrq.gov/toolssoftwre/surgflgs/surgeryflgs.jsp. Accessed August 13, 2014. 7 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

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 1988. These procedures; lproscopy; lyer closure; complex repir; extensive, complicted; penetrting wound; deep; complicted; nd tissue trnsfer. 11

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

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 2012. 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 http://www.hcup-us.hrq.gov/. For dditionl HCUP sttistics, visit HCUPnet, our interctive query system, t http://hcupnet.hrq.gov/. For informtion on other hospitliztions in the United Sttes, refer to the following HCUP Sttisticl Briefs locted t http://www.hcup-us.hrq.gov/reports/sttbriefs/sttbriefs.jsp: 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, 2003 2012 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 2014. http://www.hcupus.hrq.gov/ssdoverview.jsp. Accessed December 15, 2014. 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

Qulity. Updted September 2014. http://www.hcup-us.hrq.gov/sidoverview.jsp. Accessed September 11, 2014. Suggested Cittion Wier LM (Truven Helth Anlytics), Steiner CA (AHRQ), Owens PL (AHRQ). Surgeries in Hospitl-Owned Outptient Fcilities, 2012. HCUP Sttisticl Brief #188. Februry 2015. Agency for Helthcre Reserch nd Qulity, Rockville, MD. http://www.hcup-us.hrq.gov/reports/sttbriefs/sb188-surgeries-hospitl- 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 20850 14