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Jerome H. Liu, MD, MSHS; David A. Etzioni, MD, MSHS; Jessica B. O'Connell, MD; Melinda A. Maggard, MD; Darryl T. Hiyama, MD; Clifford Y. Ko, MD, MS, MSHS

Arch Surg. 2003;138:1106-1112.

Background  The practice environment for surgery is changing. However, little is known regarding the trends or current status of inpatient surgery at a population level.

Hypothesis  Inpatient surgical care has changed significantly over the last 10 years.

Design  Longitudinal analysis of California inpatient discharge data (January 1, 1990, through December 31, 2000).

Setting  All 503 nonfederal acute care hospitals in California.

Patients  All inpatients undergoing general, vascular, and cardiothoracic surgery in California from January 1, 1990, through December 31, 2000, were obtained.

Main Outcome Measures  Volume, mean age, comorbidity profile, length of hospital stay, and in-hospital mortality were obtained for inpatient general, vascular, and cardiothoracic surgical procedures performed during the period 1990 to 2000. Rates of change and trends were evaluated for the 10-year period.

Results  Between January 1, 1990, and December 31, 2000, 1.64 million surgical procedures were performed. The number of surgical procedures increased 20.4%, from 135 795 in 1990 to 163 468 in 2000. Overall, patients were older and had more comorbid disease in 2000 compared with 1990. Both crude and adjusted (by type of operation) in-hospital mortality decreased from 3.9% in 1990 to 2.75% (P<.001) and 2.58% (P<.001), respectively, in 2000. Length of hospital stay decreased over the period for all operations analyzed.

Conclusions  The total number of inpatient general, vascular, and cardiothoracic surgical procedures has increased over the past decade. Furthermore, our findings indicate that the outcomes of care (eg, in-hospital mortality and length of hospital stay) for patients who undergo general, vascular, and cardiothoracic surgical procedures have improved. However, continued evaluations at the population level are needed.

From the Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (Drs Liu, Etzioni, O'Connell, Maggard, Hiyama, and Ko); and the Departments of Surgery (Drs Liu, O'Connell, and Ko) and General Internal Medicine (Dr Liu), West Los Angeles Veterans Administration, Los Angeles.

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