Trends in the use of episiotomy in the United States: 1980-1998.

BACKGROUND: Despite a relative paucity of clinical evidence justifying its routine use, approximately 40 percent of all vaginal deliveries include an episiotomy. The purpose of this study is to examine trends in episiotomy in the United States from 1980 through 1998, a period during which calls increased to abandon routine episiotomy. METHODS: Data were obtained from the National Hospital Discharge Survey, which is conducted annually and based on a nationally representative sample of discharges from short-stay non-Federal hospitals. RESULTS: From 1980 through 1998 the episiotomy rate in the United States dropped by 39 percent. Rates decreased for all age and racial groups investigated, in all four geographic regions, and for all sources of payment. Significant differences remained between groups in 1998, including a higher rate for white women than for black women, and a higher rate for women with private insurance than for women with Medicaid or in the self-pay category. The incidence of first- and second-degree lacerations to the perineum increased for women without episiotomies, but the more severe third- and fourth-degree lacerations remained more frequent for women with episiotomies. Women with episiotomies were more likely to have forceps-assisted deliveries or vacuum extractions. CONCLUSIONS: Despite dramatic declines in the use of episiotomy during the last two decades, it remains one of the most frequent surgical procedures performed on women in the United States, and it continues to be performed at a higher rate for certain groups of women.

National hospital discharge survey: annual summary, 1998.

OBJECTIVES: This report presents 1998 national estimates and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by demographic characteristics of patients discharged, geographic region of hospitals, conditions diagnosed, and surgical and nonsurgical procedures performed. Measurements of hospital use include number and rate of discharges and days of care, and the average length of stay. Estimates of first-listed diagnoses, days of care, all-listed diagnoses, and all-listed procedures are presented according to their code number in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). METHODS: The estimates are based on data collected through the National Hospital Discharge Survey. The survey has been conducted annually by the National Center for Health Statistics since 1965. In 1998, data were collected for approximately 307,000 discharges. Of the 495 eligible non-Federal short-stay hospitals in the sample, 478 (97 percent) responded to the survey. RESULTS: An estimated 31.8 million inpatients were discharged from non-Federal short-stay hospitals in 1998. These patients used an estimated 160.9 million days of care. Patients 65 years of age and over accounted for 39 percent of discharges and used 48 percent of days of care. Heart disease and deliveries made up 26 percent of first-listed diagnoses. One or more procedures were reported for 63 percent of discharges. The cesarean rate per 100 deliveries increased from 20.8 in 1995 to 22.5 in 1998. An estimated 3.8 million newborn infants were discharged from short-stay hospitals after average stays of 3.2 days.

National hospital discharge survey: annual summary, 1997.

OBJECTIVES: This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 1997 and selected trend data. Estimates are provided by demographic characteristics of patients discharged, geographic region of hospitals, conditions diagnosed, and surgical and nonsurgical procedures performed. Measurements of hospital use include number and rate of discharges and days of care, and the average length of stay. METHODS: The estimates are based on data collected through the National Hospital Discharge Survey. The survey has been conducted annually by the National Center for Health Statistics since 1965. In 1997, data were collected for approximately 300,000 discharges. Of the 501 eligible non-Federal short-stay hospitals in the sample, 474 (95 percent) responded to the survey. Diagnoses and procedures were coded according to the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM.

Ambulatory and inpatient surgery: national patterns for the elderly.

In 1996 the elderly made 13.6 million visits to ambulatory and inpatient settings for surgery. This was 401.0 visits per 1,000 population, which was approximately three and a half times the rate of 114.4 for persons under 65. A total of 25.3 million procedures were performed during these visits. More of the elderly's procedures were performed during inpatient visits (14.5 million procedures) than during ambulatory visits (10.7 million procedures). Three-quarters of the procedures performed on the elderly were in four categories: operations on the eye, cardiovascular operations, operations on the digestive system, and miscellaneous diagnostic and therapeutic procedures. The leading procedures for this age group were extraction of lens, insertion of lens, arteriography and angiocardiography, and endoscopies of small and large intestines. Women who comprised the majority of the elderly population had a larger number of procedures than men, but elderly men had a higher rate per 1,000 population. The 65-74 year-old group had the largest number of procedures, followed by 75-84 year-olds and then the 85 years and older group, reflecting the decreasing population size of these age groups. But the 75-84 year and 85 years and over groups had higher rates of procedures than those aged 65 to 74.

National hospital discharge survey: annual summary, 1996.

OBJECTIVES: This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 1996 and selected trend data. Estimates are provided by demographic characteristics of patients discharged, geographic region of hospitals, conditions diagnosed, and surgical and nonsurgical procedures performed. Measurements of hospital use include number and rate of discharges and days of care, and the average length of stay. METHODS: The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually by the National Center for Health Statistics (NCHS) since 1965. In 1996, data were collected for approximately 282,000 discharges. Of the 507 eligible non-Federal short-stay hospitals in the sample, 480 (95 percent) responded to the survey. Diagnoses and procedures are coded according to the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM.

Changing patterns of surgical care in the United States, 1980-1995.

National inpatient and ambulatory surgery data were combined to examine changes over time in the location and amount of surgical care. The main pattern was a decline in the rate of inpatient operations that was outweighed by growth in ambulatory operations. However, the rate of inpatient operations did not decrease for patients age 65 years or over, despite the growth in ambulatory surgery. Other patterns seen for specific types of operations were the substitution of ambulatory for inpatient operations, increases primarily in the rate of inpatient operations, and decreases in total operations. These patterns have implications for control of health care costs.

Ambulatory and inpatient procedures in the United States, 1996.

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures performed in the United States during 1996. Data are presented by characteristics of patients, region of the country, and procedure categories for ambulatory and inpatient procedures separately and combined. METHODS: Estimates in this report are based on data collected from the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery-(NSAS). NHDS provides data on hospital inpatient care, and NSAS provides data on ambulatory surgery in hospitals and in freestanding ambulatory surgery centers. For NHDS, data were collected for approximately 282,000 discharges from 480 non-Federal short-stay hospitals (95 percent response rate). For NSAS, data were collected for approximately 125,000 ambulatory surgery discharges from 488 hospitals and freestanding ambulatory surgery centers (81 percent response rate). RESULTS: An estimated 71.9 million procedures were performed on 39.9 million discharges from hospitals and freestanding ambulatory surgery centers during 1996: 40.4 million procedures were for inpatients, and 31.5 million were for ambulatory patients. Females had more procedures than males, and the rate of procedures increased with age in ambulatory and inpatient settings. The leading procedures for ambulatory surgery patients and inpatients combined were arteriography and angiocardiography, endoscopy of small intestine, endoscopy of large intestine, and extraction of lens.

Detailed diagnoses and procedures, National Hospital Discharge Survey, 1996.

OBJECTIVES: This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 1996. Estimates of first-listed diagnoses, all-listed diagnoses, days of care for first-listed diagnoses, and all-listed procedures are shown by sex and age of patient and geographic region of hospital. METHODS: The estimates are based on data collected through the National Hospital Discharge Survey for 1996. The survey has been conducted annually by the National Center for Health Statistics since 1965. In 1996, data were collected for approximately 282,000 discharges from 480 non-Federal short-stay hospitals. Diagnoses and procedures are presented according to their code number in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).

Ambulatory and inpatient procedures in the United States, 1995.

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures performed in the United States during 1995. Data are presented by characteristics of patients, region of the country, and procedure categories for ambulatory and inpatient procedures separately and combined. METHODS: Estimates in this report are based on data collected from the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS). NHDS provides data on hospital inpatient care, and NSAS provides data on ambulatory surgery in hospitals and in freestanding ambulatory surgery centers. For NHDS, data were collected for approximately 263,000 discharges from 466 non-Federal short-stay hospitals (92 percent response rate). For NSAS, data were collected for approximately 122,000 ambulatory surgery discharges from 489 hospitals and freestanding ambulatory surgery centers (80 percent response rate). RESULTS: An estimated 69.2 million procedures were performed on 38.7 million discharges from hospitals and freestanding ambulatory surgery centers during 1995: 39.8 million procedures were for inpatients, and 29.4 million were for ambulatory patients. Females had more procedures than males, and the rate of procedures increased with age in ambulatory and inpatient settings. The leading procedures for ambulatory surgery patients and inpatients combined were endoscopy of small intestine, arteriography and angiocardiography, extraction of lens, and endoscopy of large intestine.

National Survey of Ambulatory Surgery: 1994.

In 1994, 27.7 million surgical and nonsurgical procedures were performed during 18.4 million visits to ambulatory surgery settings. Eighty-five percent of the ambulatory procedures (23.4 million) were performed in hospital-based settings and 15 percent (4.3 million) were in freestanding settings. More than half of the ambulatory procedures were in three major categories: operations on the digestive system, the eye and the musculoskeletal system. The leading ambulatory procedures were extraction of lens (performed almost 2 million times), endoscopy of large intestine with or without biopsy (1.8 million) and insertion of prosthetic lens (1.6 million). Women had significantly more ambulatory surgery procedures than men. The ambulatory procedure performed most frequently on children under 15 was myringotomy. Also common for children were tonsillectomies and adenoidectomies. For those aged 15-44, frequently performed ambulatory procedures included endoscopies of large and small intestine; dilation and curettage of uterus; bilateral destruction or occlusion of fallopian tubes; and arthroscopy of knee. In the 45-64 year old group, endoscopies of large and small intestine were the most commonly performed ambulatory procedures. Extraction of lens and insertion of prosthetic lens were the leading ambulatory procedures for those 65 years and older, though endoscopies of large and small intestine were also performed frequently for this age group.

Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups.

OBJECTIVES: The National Hospital Discharge Survey (NHDS) was used to evaluate potentially avoidable hospital conditions as an indicator of equity and efficiency in the US health care system. METHODS: With the use of 1990 data from the NHDS, the National Health Interview Survey, and the census, national rates of hospitalization were calculated for avoidable conditions by age, race, median income of zip code, and insurance status. RESULTS: An estimated 3.1 million hospitalizations were for potentially avoidable conditions. This was 12% of all hospitalizations in 1990 (excluding psychiatric admissions, women with deliveries, and newborns). Rates of potentially avoidable hospitalizations were higher for persons living in middle- and low-income areas than for persons living in high-income areas, and were higher among Blacks than among Whites. These class and racial differences were also found among the privately insured. Differences among income and racial groups for persons aged 65 and over were not significant. CONCLUSIONS: Inequalities in potentially avoidable hospitalizations suggest inequity and inefficiency in the health care delivery system. Avoidable hospital conditions are a useful national indicator to monitor access to care.

Ambulatory surgery in the United States, 1994.

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures done on an ambulatory basis in hospitals and freestanding ambulatory surgery centers in the United States during 1994. Data are presented by types of facilities, age, sex, geographic region, and disposition for ambulatory surgery visits. Major categories of procedures and diagnoses are shown by age, sex, and region. METHODS: The estimates are based on data collected from the national Survey of Ambulatory Surgery, conducted for the first time in 1994 by the national Center for Health Statistics. The 1994 data were abstracted from 118,000 medical records in 494 hospitals and freestanding ambulatory surgery centers.

Ambulatory and inpatient procedures in the United States, 1994.

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures performed in the United States during 1994. Data are presented by characteristics of patients, region of the country, and procedure categories for ambulatory and inpatient procedures separately and combined. METHODS: Estimates in this report are based on data collected from the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS). The NHDS provides data on hospital inpatient care, and the NSAS provides data on ambulatory surgery in hospitals and in freestanding ambulatory surgery centers. For the NHDS, data were collected for approximately 277,000 discharges from 478 non-Federal short-stay hospitals (93 percent response rate). For the NSAS, data were collected for about 118,000 ambulatory surgery discharges from 494 hospitals and freestanding ambulatory surgery centers (80 percent response rate). RESULTS: An estimated 68.4 million procedures were performed on 38.0 million discharges from hospitals and freestanding ambulatory surgery centers during 1994: 40.7 million procedures were for inpatients, and 27.7 million were for ambulatory patients. Females had more procedures than males did and the rate of procedures increased with age in both ambulatory and inpatient settings. The leading procedures for ambulatory surgery patients and inpatients combined were endoscopy of large intestine, arteriography and angiocardiography, endoscopy of small intestine, and extraction of lens.

Patterns of hospital use by patients with diagnoses related to HIV infection.

The authors analyzed the use of hospitals by patients with a diagnosis of human immunodeficiency virus (HIV) infection, using data from the National Hospital Discharge Survey. In the period 1984-90, the rates of both discharges and days of care for HIV-infected patients rose dramatically. For 1988-90, black males had the highest HIV-related discharge rate, followed by white males and black females, whose rates were similar. The discharge rate for patients with HIV-related diagnoses increased more in the Northeast than in the three other regions of the country. By 1990 the rate for the Northeast was nearly triple the rate for other major regions. More than half of female and black patients with HIV-related diagnoses were hospitalized in the Northeast. Private insurance was the principal expected source of payment for the care of half of the HIV-infected patients discharged in 1985, but for only a third in 1990. Medicaid covered 40 percent of the patients with HIV-related diagnoses discharged in 1990. Larger proportions of female than male patients and of black patients than white patients were covered by Medicaid. Acquired immunodeficiency syndrome was the diagnosis coded for most patients with an HIV-related diagnosis, but in larger proportions for patients who were male or white patients. Nonspecific HIV diagnoses were coded for larger proportions of female and black patients. HIV-infected patients had an average of 3.6 diagnoses in addition to their HIV diagnosis. Nearly a fourth of the additional diagnoses were for other infectious diseases, such as pneumocystosis or candidiasis. Anemia, pneumonia, and drug use and dependence also were frequent diagnoses.

Long-stay patients in short-stay hospitals.

In 1980 and 1990, only 4-5 percent of patients in short-stay hospitals were hospitalized for more than 3 weeks. The number of discharges and days of care for these long-stay patients were lower in 1990 as compared with 1980, but they continued to use more than a quarter of all hospital days in 1990. Long-stay patients were more likely than all patients to be 65 years of age and over and have Medicare as their expected principal source of payment. For long-stay and all patients, private insurance covered smaller proportions of discharges and days of care, and Medicaid covered larger proportions in 1990 than in 1980. Long-stay patients were more likely than all patients to be discharged dead or transferred to other hospitals or nursing homes. Long-stay and all patients were more likely to be transferred at discharge in 1990 than in 1981. The Northeast Region had a larger proportion of long-stay patients than of all patients, and that proportion increased from 1980 to 1990. The proportion of long-stay discharges and days of care in the Midwest decreased during this period. In 1980 and 1990, more than 50 percent of the discharges and days of care for long-stay patients were for diseases of the circulatory system, mental disorders, neoplasms, or injury and poisoning. Despite the overall decreases in hospital use by long-stay patients, their discharges and days of care increased significantly from 1980 to 1990 for diagnoses such as septicemia, psychoses, and miscellaneous complications of surgical and medical care. Over time, decreases were seen in long-stay discharges and days of care for a variety of diagnostic categories, including malignant neoplasm of trachea, bronchus, and lung; diabetes mellitus; and fracture of the neck of the femur. Long-stay patients had a higher rate of procedures per 1,000 discharges in 1990 than in 1980, and a higher rate than all patients in both years. Approximately half of all the procedures performed on long-stay patients in 1980 and two-thirds in 1990 were miscellaneous diagnostic and therapeutic procedures, operations on the cardiovascular system, or operations on the digestive system. The rates of numerous procedures, especially diagnostic tests, increased for long-stay and all patients from 1980 to 1990.