The results presented in this report are drawn from the Healthcare Cost and Utilization Project (HCUP), a Federal-State-Industry partnership to build a multi-State health care data system. This partnership is sponsored by the Agency for Healthcare Research and Quality (AHRQ) and is managed by staff in AHRQ's Center for Delivery, Organization, and Markets (CDOM). HCUP is based on data collected by individual HCUP Partners (including State departments of health, hospital associations, and private agencies), which provide these data to AHRQ. HCUP would not be possible without statewide data collection projects and their partnership with AHRQ.
For the year 2003, 38 HCUP Partners contributed their data to AHRQ, where all files were validated and converted into a uniform format. The uniform HCUP databases enable comparative studies of health care services and the use and cost of hospital care, including:
HCUP includes short-term, non-Federal, community hospitals, as defined by the American Hospital Association (AHA). This definition encompasses general hospitals and specialty facilities, such as pediatric, obstetrics-gynecology, short-term rehabilitation, and oncology hospitals. Long-term care and psychiatric hospitals are excluded, as are substance abuse treatment facilities.
HCUP includes several sets of inpatient and outpatient databases for health services research. This report is based on the 2003 State Inpatient Databases (SID) and the 2003 State Ambulatory Surgery Databases (SASD). The SID contain the universe of the inpatient discharge abstracts in 38 Partner States, translated into a uniform format to facilitate multi-State comparisons and analyses. The SASD capture surgeries performed on the same day in which patients are admitted and released. All of the SASD databases from 20 Partner States include abstracts from hospital-affiliated ambulatory surgery sites. Some contain the universe of ambulatory surgery encounter abstracts for that State, including records from both hospital-affiliated and freestanding surgery centers.
This report evaluates inpatient and outpatient surgery data from 17 selected States that contributed data to both the 2003 SASD and SID: Colorado, Connecticut, Georgia, Indiana, Kentucky, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, New York, North Carolina, South Carolina, Tennessee, Utah, Vermont, and Wisconsin.iii
iiiAlthough 20 States contributed to both the 2003 SASD and SID, only 17 used the ICD-9-CM procedure codes (rather than CPT codes) necessary for this report.
This Fact Book is based on data in the HCUP SID and the SASD. Selected methodological issues relevant to this report follow.
For this report, any reference to "visit" or "hospital stay" indicates that the unit of analysis is the record rather than the surgical procedure.Any reference to "surgeries" indicates that the unit of analysis is a major operating room procedure. Multiple surgical procedures can be listed on a record in the SID and SASD. Frequencies and rankings of surgeries are based on all-listed—that is, all surgical procedures listed on the record—and de-duplicated procedures. If a particular procedure occurs multiple times during the same surgical visit or hospital stay, it is counted only once.
Records from the SASD meeting the following criteria were included:
Records from the SID meeting similar criteria were included:
The Procedure Classes tool provides an easy way to categorize ICD-9-CM procedure codes into 1 of 4 broad categories: major diagnostic, major therapeutic, minor diagnostic, and minor therapeutic. This tool was created to facilitate health services research on hospital procedures using administrative data. All ICD-9-CM procedure codes are assigned to 1 of the following categories:
This Fact Book examines only ambulatory and inpatient hospital discharge records where at least one ICD-9-CM procedure code was classified as either a major diagnostic or major therapeutic procedure.
More detailed information on the Procedure Classes tool can be obtained from the HCUP User Support Web site at: http://www.hcup-us.ahrq.gov/toolssoftware/procedure/procedure.jsp.
Surgical procedures are recorded within the HCUP databases using ICD-9-CM codes. Although ICD-9-CM codes may be used to provide descriptive statistics, the granular nature of these codes is difficult to summarize. Thus, for this report, the AHRQ-developed Clinical Classifications Software (CCS) is used to aggregate ICD-9-CM procedure codes into a limited number of clinically meaningful categories for most tables. More detailed information on CCS can be downloaded from the HCUP User Support Web site at: http://www.hcup-us.ahrq.gov/home.jsp.
Payer is the expected payer for the surgical visit or hospital stay. To make coding uniform across all HCUP data sources, "Payer" combines detailed categories into more general groups:
Up to two payers can be coded for a surgical visit or hospital stay in HCUP data.When this occurs, the following hierarchy is used:
Charges in HCUP data are the amount the hospital charged or billed for the entire surgical visit or hospital stay and do not reflect charges for individual surgical procedures. Charges do not necessarily reflect reimbursements or costs and do not include most professional (physician) fees. Cost-to-charge ratios are available to convert inpatient hospital charges to inpatient hospital costs, but an equivalent ratio for outpatient hospital data is currently not available.
Part II of this report provides detailed statistics for specific surgeries and populations. These surgeries have been identified using the following ranges of ICD-9-CM procedure codes or CCS categories:
| Surgeries | ICD-9-CM Codes | CCS Procedure Category |
|---|---|---|
| Appendectomy | Procedure codes: 47.01-47.19 | 80 |
| Cholecystectomy and common duct exploration | Procedure codes: 51.21-51.24 or 51.41-51.59 | 84 |
| Hernia repair | Procedure codes: 53.00-53.39 | 85 |
| Bariatric surgery | Procedure codes: 43.81-43.89, 44.31, 44.39, 44.50-44.59, 44.69,45.90, or 45.91 and Diagnosis codes: 278.00-278.01 Excludes records with at least one cancer diagnosis in the following range: 150.0-159.9 |
— |
| Tonsillectomy and/or adenoidectomy | Procedure codes: 28.2-28.3 or 28.6-28.7 | 30 |
| Mastectomy | Procedure codes: 85.41-85.48 | 167 |
| Hysterectomy | Procedure codes: 68.3-68.9 | 124 |
| Transurethral prostatectomy (TURP) | Procedure codes: 60.21-60.29 or 60.96-60.97 | 113 |
1 National Center for Health Statistics. Health, United States, 2004 with chartbook on trends in the health of Americans. Hyattsville, MD: 2004.
2 Kozak LJ, McCarthy E, Pokras R. Changing patterns of surgical care in the United States, 1980–1995. Health Care Finance Rev. 1999 Fall;21(1):31–49.
3 U.S. Census Bureau, Population Division. Annual estimates of the population for the United States and States, and for Puerto Rico: April 1, 2000 to July 1, 2005. http://www.census.gov/popest/states/NSTann-est.html. (Accessed May 9, 2006).
4 DeNavas-Walt C, Proctor BD,Mills RJ. Income, poverty, and health insurance coverage in the United States: 2003. Current Population Reports, P60-226.Washington, DC: U.S. Census Bureau, 2004. http://www.census.gov/prod/2004pubs/p60-226.pdf. (Accessed May 9, 2006).
5 American Hospital Association. Fast facts on US hospitals. Updated November 14, 2005. http://www.aha.org/aha/resource-center/Statistics-and-Studies/fast-facts.html. (Accessed October 17, 2006).
6 U.S. Census Bureau, Population Division. Annual estimates of the population by sex, race, and Hispanic or Latino origin for States: April 1, 2000 to July 1, 2004. http://www.census.gov/popest/states/asrh/SC-est2004-03.html. (Accessed May 9, 2006).
7 U.S. Census Bureau, Population Division. Estimates of the resident population by selected age groups for the United States and States and for Puerto Rico: July 1, 2004. http://www.census.gov/popest/states/asrh/SC-est2004-01.html. (Accessed May 9, 2006).
8 American College of Surgeons.When you need an operation: about appendectomy. http://www.facs.org/public_info/operation/app.pdf#search=%22American%20College%20of%20Surgeons%20 About%20Appendectomy%22. (Accessed August 10, 2006).
9 Reddick RJ, Olsen DO. Outpatient laparoscopic laser cholecystectomy. Am J Surg. 1990 Nov;160(5):485–7.
10 Encinosa WE, Bernard DM, Steiner CA, Chen CC. Use and costs of bariatric surgery and prescription weight-loss medications. Health Aff (Millwood). 2005 Jul-Aug;24(4):1039–46.
11 Brigger MT, Brietzke SE. Outpatient tonsillectomy in children: a systematic review. Otolaryngol Head Neck Surg. 2006 Jul;135(1):1–7.
12 Lalakea ML,Marquez-Biggs I,Messner AH. Safety of pediatric short-stay tonsillectomy. Arch Otolaryngol Head Neck Surg. 1999 Jul;125 (7):749–52.
13 Kaiser Family Foundation. State mandated benefits: coverage of
inpatient mastectomy stay, 2004.
http://www.statehealthfacts.kff.org/cgi-bin/healthfacts.cgi?action=compare&category=Women%27s+Health&subcategory=
Mandated+Benefits+in+Private+Insurance&topic=Minimum+IP+Mastectomy+Stay. (Accessed April 21, 2006).
14 Dooley WC. Ambulatory breast cancer surgery. Ann Surg Oncol. 2000 Apr;7(3):174–5.
More information regarding HCUP data is available at http://www.ahrq.gov/data/hcup, as well as on the HCUP User Support Web site at http://www.hcup-us.ahrq.gov.
SASD data are available for purchase for the following data years and numbers of States:
SID data are available for purchase for the following data years and numbers of States:
SASD and SID data can be purchased for research through the HCUP Central Distributor sponsored by AHRQ: Social and Scientific Systems, Inc., telephone: 866-556-4287 (toll-free), fax: 301-628-3201, or E-mail: hcup@s-3.com. The HCUP Central Distributor can provide information on which States are included in both databases for any year.
Price of the data ranges from $20 to $3,170, depending on the data file, State, and requesting organization. Prices may be higher for customers outside the United States, Canada, and Mexico.
AHRQ is always looking for ways in which AHRQ-funded research, products, and tools have changed peoples' lives, influenced clinical practice, improved policies, and affected patient outcomes. Impact case studies describe AHRQ research findings in action. These case studies have been used in testimony, budget documents, and speeches. If you are aware of any impact your research has had on health care policy, clinical practice, or patient outcomes, please let us know by using the contact information below.
Healthcare Cost and Utilization Project (HCUP)
Center for Delivery, Organization, and Markets
Agency for Healthcare Research and Quality
Phone: 866-290-HCUP (866-290-4287)
E-mail: hcup@ahrq.gov
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The authors acknowledge the following for their contributions to this Fact Book: Devi Katikineni, Andy Mosso, and Tess Monasterio (SSS) for statistical programming; Gail Eisen and Nancy Jordan (Thomson Medstat) and DonnaRae Castillo (AHRQ) for editorial services; Katheryn Ryan (Thomson Medstat) for administrative support; and The Madison Design Group for design and layout.
AHRQ Publication No. 07-0007
Current as of January 2007
Internet Citation:
Russo CA, Owens P, Steiner C, Josephsen J. Ambulatory Surgery in U.S. Hospitals, 2003—HCUP Fact Book No. 9. AHRQ Publication No. 07-0007, January 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/data/hcup/factbk9/
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