Rutkow I M
Surgery. 1987 Feb;101(2):192-200.
With data from the National Center for Health Statistics, an in-depth analysis of the number of surgical operations performed in the United States from 1979 to 1984 was carried out. During the study period, there was a 9% increase in the total number of surgical procedures. For the same time period, the number of surgeons grew 20%. By 1984 general surgical operations were greatest in number. However, the 5-year increase in the number of general surgical operations was just 7%. Although obstetric and gynecologic operations declined 1%, the most common inpatient surgical operation performed in the United States is cesarean section. Orthopedic surgical operations grew 24% and arthroscopy has become this country's sixteenth most frequent operation. Cataract extraction is the fourth most common operation and represents 60% of all ophthalmologic surgery. Cardiothoracic operations had the largest increase, 34%. This study demonstrates the dynamics of surgical practice in the United States and conveys a dual message. There is reassuring news concerning "unnecessary" surgery due to supplier-induced demand for operations. Despite recent large increases in the number of surgeons, there have not been parallel increases in the number of surgical operations. The belief that more surgeons necessarily means more surgery is not noted. The disturbing news concerns surgical case loads. The prospect of more surgeons performing fewer operations has become a major problem. The surgical community will have to address this growing inbalance.
利用美国国家卫生统计中心的数据，对1979年至1984年美国实施的外科手术数量进行了深入分析。在研究期间，外科手术的总数增加了9%。同一时期，外科医生的数量增长了20%。到1984年，普通外科手术的数量最多。然而，普通外科手术数量的5年增幅仅为7%。尽管妇产科手术数量下降了1%，但美国最常见的住院外科手术是剖宫产。骨科手术数量增长了24%，关节镜检查已成为该国第16种最常见的手术。白内障摘除术是第四常见的手术，占所有眼科手术的60%。心胸外科手术的增幅最大，为34%。这项研究展示了美国外科手术实践的动态，并传达了双重信息。关于因供应商诱导的手术需求而进行的“不必要”手术，有令人安心的消息。尽管最近外科医生的数量大幅增加，但手术数量并未随之相应增加。那种认为外科医生越多必然意味着手术越多的观点并未得到证实。令人不安的消息涉及手术病例数量。外科医生增多但手术数量减少的前景已成为一个主要问题。外科界将不得不应对这种日益加剧的不平衡。
