Pritzker School of Medicine of the University of Chicago, Chicago, IL, USA.
Anesth Analg. 2010 Jun 1;110(6):1686-97. doi: 10.1213/ANE.0b013e3181cbd9cc. Epub 2010 Feb 8.
To anticipate future changes to the practice of neuroanesthesia, we examined the nationwide trends in frequently performed operative neurosurgery.
We used the Nationwide Inpatient Sample, a random sampling of approximately 20% of United States hospitals from 1993 to 2007. Eight categories of operative neurosurgery were developed, based on procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). We tabulated total volume, mean length of stay, and inhospital mortality and calculated growth rates over the entire period, the most recent 5-year period, and the most recent 2-year period. We examined annual volumes from 1993 to 2007 for each neurosurgical category for the most common ICD-9-CM procedure code within each category.
Intracranial endovascular procedures had the highest compound annual growth rate over the entire study period (32%), the most recent 4 years (29%), and the most recent 2 years (12%). Craniotomy for vascular surgery decreased over the entire period (-4.2%). Spinal fusion had the largest absolute increase over the study period (from 54,000 in 1993 to 350,000 in 2007). All categories except craniotomy for vascular surgery had decreased length of stay across the study period, with compound annual growth rates of -1.2% (ventricular and thecal shunt) to -6.6% (deep brain stimulation). Intracranial endovascular procedures had a much higher growth rate of length of stay than vascular surgery over the most recent 2-year (14% vs 1.0%) and 5-year periods (5.6% vs 1.5%).
The highest volume trends in operative neurosurgery are for spinal fusion (increasing at a rate of approximately 12,000 procedures/y), craniotomy for tumors and other purposes (increasing at a rate of approximately 2,700 procedures/y), and a decrease in shunts (decreasing at a rate of approximately 3,000 per year). The data suggest that intracranial endovascular treatment remains relatively rare, but it is growing exponentially, and lengths of stay are increasing, whereas inhospital deaths are decreasing. The conclusions of this study are limited by the imprecise nature of the ICD-9-CM procedure codes, the categorization scheme we used, and by the sampling methods of the National Inpatient Sample.
为了预测神经外科学实践的未来变化，我们研究了经常进行的手术神经外科学的全国趋势。
我们使用了全国住院患者样本，这是对 1993 年至 2007 年美国约 20%的医院进行的随机抽样。根据国际疾病分类，第九修订版，临床修正（ICD-9-CM）的程序代码，我们开发了 8 类手术神经外科学。我们列出了整个时期、平均住院时间和院内死亡率的总量，并计算了整个时期、最近 5 年和最近 2 年的增长率。我们检查了 1993 年至 2007 年每个神经外科学类别的年度量，以获得每个类别的最常见 ICD-9-CM 程序代码。
颅内血管内治疗在整个研究期间（32%）、最近 4 年（29%）和最近 2 年（12%）的复合年增长率最高。血管手术开颅术在整个期间减少（-4.2%）。脊柱融合在研究期间绝对增加最多（从 1993 年的 54,000 例增加到 2007 年的 350,000 例）。除血管手术开颅术外，所有类别在整个研究期间的住院时间都有所缩短，复合年增长率为-1.2%（脑室和鞘内分流）至-6.6%（深部脑刺激）。颅内血管内治疗的住院时间增长速度远高于血管手术，最近 2 年（14%对 1.0%）和 5 年（5.6%对 1.5%）。
手术神经外科学中最高的量趋势是脊柱融合（以每年约 12,000 例的速度增加）、肿瘤和其他目的的开颅术（以每年约 2,700 例的速度增加）以及分流术的减少（每年减少约 3,000 例）。数据表明，颅内血管内治疗仍然相对较少，但呈指数增长，住院时间增加，而院内死亡率下降。本研究的结论受到 ICD-9-CM 程序代码的不精确性质、我们使用的分类方案以及全国住院患者样本的抽样方法的限制。
