Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
J Vasc Surg. 2012 May;55(5):1394-9; discussion 1399-400. doi: 10.1016/j.jvs.2011.11.061. Epub 2012 Jan 16.
The purpose of this study was to analyze the trend in inpatient vascular procedures in the United States over the past decade and predict the future demand for vascular surgeons.
The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was queried to determine the weighted national estimates of inpatient vascular procedures performed on adult patients (age ≥ 18) between 1997 and 2008. Using population estimates from the United States Census Bureau, the per capita rates of inpatient procedures were calculated for age-specific groups (18-64 years, 65-84 years, and ≥ 85 years). The change in per capita rates over the past decade along with population forecasts were used to predict future workload.
There was a net increase of 22% from 971,046 inpatient vascular procedures for all adults in 1997 to 1,188,332 in 2008. During the same time period, the adult population increased by 16% from 198 to 230 million. The age-stratified per capita rates of all vascular procedures were +21% for age 18 to 64; -4% for age 65 to 84; and +18% for age ≥ 85. This resulted in a net increase of 5% (490 to 515 procedures per 100,000 capita) in the per capita rate for all adults. Based on the assumption that trends in age-specific rates remain constant, there is a predicted inpatient workload increase (compared to 2008) of 18% by 2015, 34% by 2020, and 72% by 2030. The vascular workload is predicted to more than double by the year 2040.
Despite a conservative approach of using a population-based analysis of only inpatient procedures, there is a dramatic increase in the predicted vascular workload for the future. The vascular surgery training process will need to adapt to ensure an adequate number of fellowship-trained vascular surgeons is available to provide quality vascular care in the future.
本研究旨在分析过去十年中美国住院血管手术的趋势，并预测未来对血管外科医生的需求。
通过查询医疗保健成本和利用项目全国住院患者样本，确定了 1997 年至 2008 年间对成年患者（年龄≥18 岁）进行的住院血管手术的全国加权估计。利用美国人口普查局的人口估计数，计算了特定年龄组（18-64 岁、65-84 岁和≥85 岁）的每例住院手术率。过去十年中每例手术率的变化以及人口预测被用于预测未来的工作量。
与 1997 年相比，所有成年人的住院血管手术总数从 971,046 例增加到 2008 年的 1,188,332 例，增长了 22%。在此期间，成年人数量从 198 年增加到 230 年，增长了 16%。所有血管手术的年龄分层每例手术率在 18-64 岁时增加了 21%，在 65-84 岁时减少了 4%，在≥85 岁时增加了 18%。这导致所有成年人的每例手术率净增长 5%（每 10 万人增加 490 至 515 例手术）。基于特定年龄组的趋势保持不变的假设，到 2015 年，预计住院工作量将增加 18%，到 2020 年增加 34%，到 2030 年增加 72%。到 2040 年，血管手术量预计将增加一倍以上。
尽管采用了仅基于住院手术的基于人群的分析方法，但未来血管手术工作量的预测仍呈急剧上升趋势。血管外科学培训过程需要适应，以确保有足够数量的接受过 fellowship 培训的血管外科医生能够在未来提供高质量的血管护理。
