Anderson Patrice L, Gelijns Annetine, Moskowitz Alan, Arons Ray, Gupta Lopa, Weinberg Alan, Faries Peter L, Nowygrod Roman, Kent K Craig
International Center for Health Outcomes and Innovation Reseach (InCHOIR), New York Presbyterian Hospital, Department of Surgery, 600 W. 168th Street, New York, NY 10032, USA.
J Vasc Surg. 2004 Jun;39(6):1200-8. doi: 10.1016/j.jvs.2004.02.039.
To help understand past and future trends in vascular intervention, we examined changes in the rate of utilization, patient demographics, and length of stay from 1980 to 2000.
We reviewed the ICD-9 codes for all vascular procedures using the National Hospital Discharge Survey of non-federal United States hospitals (1980-2000).
The number of vascular procedures performed in this country increased from 412,557 in 1980 to 801,537 in 2000 (per capita increase of >50%). This increase was most evident in elderly patients (>75 years, 67% per capita increase in discharges). Long hospital stays (> or =7 days) for vascular procedures fell 41%, and short hospital stays (<24 hours) increased 15% over the period of study. The frequency of abdominal aortic aneurysm repairs remained relatively constant. Except for an interval in the late 1980s, and a minor decrease from 1997 to 2000, the frequency of carotid endartarectomy rose dramatically (69%). Lower extremity revascularizations increased steadily until 1990 but then declined 12%. From 1995 to 2000, there was a 27% per capita decrease in the number of renal-mesenteric operations. Correspondingly, over the past 5 years there has been a 979% growth in the number of percutaneous/endovascular interventions. Despite a substantial number of interventions for lower extremity vascular disease, there was a concomitant increase in the number of major and minor amputations.
Interventions for vascular disease have increased dramatically, with a major shift toward less invasive treatments, particularly for the renal and mesenteric vessels and the lower extremities. These trends in procedural use suggest that vascular surgeons need to embrace catheter-based approaches if they want to remain leaders in the treatment of peripheral vascular diseases.
为了帮助了解血管介入治疗的过去和未来趋势，我们研究了1980年至2000年期间血管介入治疗的使用率、患者人口统计学特征及住院时间的变化情况。
我们使用美国非联邦医院全国出院调查（1980 - 2000年）的数据，对所有血管手术的国际疾病分类第九版（ICD - 9）编码进行了回顾。
该国进行的血管手术数量从1980年的412,557例增加到2000年的801,537例（人均增长超过50%）。这种增长在老年患者（>75岁，出院人数人均增长67%）中最为明显。在研究期间，血管手术的长时间住院（≥7天）率下降了41%，短时间住院（<24小时）率增加了15%。腹主动脉瘤修复手术的频率保持相对稳定。除了20世纪80年代后期有一个时间段，以及1997年至2000年略有下降外，颈动脉内膜切除术的频率大幅上升（69%）。下肢血管重建术在1990年之前稳步增加，但随后下降了12%。从1995年到2000年，肾肠系膜手术的人均数量下降了27%。相应地，在过去5年中，经皮/血管内介入治疗的数量增长了979%。尽管对下肢血管疾病进行了大量干预，但大截肢和小截肢的数量也随之增加。
血管疾病的介入治疗显著增加，且主要转向侵入性较小的治疗方法，特别是对于肾血管、肠系膜血管和下肢血管疾病。这些手术使用趋势表明，如果血管外科医生想在周围血管疾病治疗领域保持领先地位，就需要采用基于导管的治疗方法。
