Urological operations in the United States: 1979 to 1984

With data from the National Center for Health Statistics an in-depth analysis of numbers of urological operations from 1979 to 1984 was performed. During the 5-year study period there was an increase in total numbers of urological operations of 7 per cent, while the number of urological surgeons increased 18 per cent. In 1983 urologists performed 1,680,000 operations. Prostatectomy (357,000) was the most common urological procedure and the tenth most frequent operation in this country. The 20 most common urological operations constitute 69 per cent of all urological operations. In 1983 urological operations represented 9 per cent of all procedures completed in this country. These figures illustrate the dynamics of urological surgical practice. The numbers of urological operations have increased minimally during the last 5 years despite constantly increasing numbers of urologists. The belief that urological operative rates will inevitably increase as the number of urologists increases is not supported by this study.     

General surgical operations in the United States. 1979 to 1984

Utilizing data from the National Center for Health Statistics, an in-depth analysis of numbers of general surgical operations from 1979 to 1984 was performed. During the study period, there was an increase in the total number of general surgical operations of 7%. During the same five-year period the number of general surgeons increased by 13%. The 25 most common general surgical operations constitute 71% of all general surgical operations. In 1983, general surgical operations represented 27% of all surgical procedures completed in this country. These statistics illustrate the dynamics of general surgical practice. They show that the number of general surgical operations has minimally increased over the last five years, despite a constantly increasing number of general surgeons. If current trends continue, then future individual operative workloads will decrease with possible adverse effects on the quality of general surgical care.     

Thoracic and cardiovascular operations in the United States, 1979 to 1984

Using data from the National Center for Health Statistics, I conducted an in-depth analysis of numbers of thoracic and cardiovascular operations from 1979 to 1984. This is the first full 5 year period since the inception of International Classification of Diseases, Ninth Revision, Clinical Modification codes, and the findings delineate the present status of thoracic and cardiovascular surgery in the United States. During the study period there was a 34% increase in total numbers of thoracic and cardiovascular operations. Since 1970 there has been a total increase in numbers of thoracic and cardiovascular operations of 150%. In 1983 thoracic and cardiovascular surgeons performed 191,000 coronary artery bypasses. This operation is the most common thoracic and cardiovascular procedure and has become the nineteenth most common operation now performed in this country. Pacemaker placement, revision, or removal (190,000) is the second most common thoracic and cardiovascular operation and the country's twentieth. The twenty most common thoracic and cardiovascular operations constitute 87% of all thoracic and cardiovascular operations. In 1983 thoracic and cardiovascular operations represented 3% of all operations completed in this country. These figures represent the dynamics of thoracic and cardiovascular surgical practice. They demonstrate that numbers of thoracic and cardiovascular operations have consistently increased over the past 15 years. However, this increase is almost entirely due to the advent of coronary artery bypass.     

Surgical operations in the United States: 1979 to 1984

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.     

Orthopaedic surgeons do not increase surgical volume after investing in a specialty hospital

BACKGROUND: The number of surgical specialty hospitals with physician investors in the United States has increased in the last ten years. Opponents to these hospitals have argued that surgeon investors will perform more surgery in order to maintain the hospital's profitability. The purpose of the present study was to determine whether the surgical volume or the surgical rate increased for a group of ten orthopaedic surgeons after the opening of an orthopaedic surgery specialty hospital in which they held a financial interest. METHODS: We analyzed the practice data for ten orthopaedic surgeons during an interval spanning seven years before and eight years after the opening of an orthopaedic surgery specialty hospital in which they held a financial interest. The average rates of change in the number of surgical procedures per year for each period were computed and compared with use of regression analysis. The percentages of patients who underwent surgery before and after the opening of the specialty hospital were also compared. RESULTS: The ten orthopaedic surgeons did not increase their surgical volume or surgical rate after the specialty hospital opened. The ten surgeons performed an average of 4399 surgical procedures per year before the hospital opened and 4542 surgical procedures per year after the hospital opened. The rate of change in the number of surgical procedures per year (19.1 compared with 8.9 procedures per year) did not increase after the specialty hospital opened. The annual patient volume (16,019 compared with 15,982 patients) and the percentage of patients who underwent surgery (27.5% compared with 28.4%) did not significantly change after the specialty hospital opened. CONCLUSIONS: The opening of an orthopaedic surgery specialty hospital did not increase the surgical volume or the surgical rate for ten orthopaedic surgeons who held a financial interest in the facility.     

Complications of biliary surgery

Procedures on the gallbladder and extrahepatic biliary tract were the most frequently performed operations in a series of 1500 consecutive abdominal operations done in community hospitals. The operative mortality rate for elective cholecystectomy was 0.3 per cent. The complication rate was 21.4 per cent for cholecystectomy. Patients requiring emergency cholecystectomy had significantly more urinary tract and intra-abdominal problems than those patients who underwent surgery electively. Operative cholangiography was performed during 20.3 per cent of the elective cholecystectomies. There were no biliary tract complications among the cholecystectomy patients who had cholangiography. When this study was not performed, 1.5 per cent of the patients had postoperative bile duct problems. Older surgeons (greater than 60 years of age) and high volume surgeons (greater than 300 cases/year) were significantly less likely to employ cholangiography. The mortality rate for elective common duct exploration was 4.4 per cent, with a complication rate of 60 per cent. There was a 13.3 per cent incidence of retained stones after choledochotomy, though this problem was readily managed by percutaneous extraction through the T-tube tract. Complex biliary tract procedures were performed electively without mortality, though the complication rate for these procedures was 35.3 per cent. Two-thirds of the patients undergoing complex biliary tract operations on an emergency basis died. Board certified general surgeons had the same mortality and complication rates for cholecystectomy as well as common bile duct exploration. Noncertified surgeons had significantly more intraabdominal complications after complex biliary tract procedures compared to their board certified colleagues.     

Changing attitudes toward management of cancer of the colon and rectum

Changes in the attitudes of surgeons toward the management of cancer of the colon and rectum over a 5-year period were assessed by analysis of responses of general surgeons to a 21-item questionnaire on colon cancer from 1978 and 1983. Comparisons of the responses revealed that the use of routine preoperative liver scans has decreased from 57 to 45 per cent. Transanal resection of villous adenoma of the rectum is used more often (44% in 1983 versus 34% in 1978). For obstructing carcinoma of the colon, a two-stage procedure is used more often, with 46 per cent of the respondents in favor of this approach in 1983 compared with 29 per cent in 1978. The use of staplers for colon anastomoses following resection has also increased with 44 per cent surgeons in 1983 using this technique always or frequently compared with 21 per cent in 1978. Following anterior resection, 66 per cent of respondents in 1983 seldom or never use a transverse colostomy (54% in 1978). The number of surgeons closing the perineal wound over suction drains following an abdominoperineal resection has increased from 46 per cent (1978) to 63 per cent in 1983. Sphincter-saving procedures for carcinoma of the rectum are used by a large number of surgeons in 1983 (29% versus 9% in 1978). An increase is noted in the use of preoperative radiation therapy for selected cases of rectal cancer (53% in 1978 to 68% in 1983).(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of the volume of scoliosis surgery between spine and pediatric orthopaedic fellowship-trained surgeons in New York and California

BACKGROUND: Controversy exists regarding the optimal fellowship training experience for surgeons who perform scoliosis surgery in pediatric patients. While many studies have demonstrated that higher surgical volumes are associated with superior outcomes, the volume of scoliosis procedures performed by pediatric orthopaedic-trained surgeons as opposed to spine surgery-trained surgeons has not been reported. METHODS: Validated, statewide hospital discharge databases from the states of New York and California were utilized to examine the volume of spinal fusion procedures performed for the treatment of scoliosis in patients who were eighteen years of age or less. Fellowship training of surgeons in New York who had performed more than fifty procedures from 1992 to 2001 (that is, more than five procedures per year) was determined, and the operative volumes of surgeons who had received pediatric orthopaedic as opposed to spine fellowship training were compared. Hospitals in California with either type of fellowship program were identified, and the operative volumes of hospitals and fellows with pediatric orthopaedic or spine fellowship training from 1995 to 1999 were compared. RESULTS: Among the 228 surgeons in New York who had performed one or more spinal fusion procedures in patients eighteen years of age or less from 1992 to 2001, only 13% (thirty) had performed more than five procedures per year. However, these thirty surgeons accounted for 75% (3858) of all 5136 procedures in this age-group. Surgeons who had completed a pediatric orthopaedic fellowship had performed a mean of 14.5 procedures per physician per year, whereas those who had completed a spine fellowship had performed a mean of 10.5 procedures per physician per year. Surgeons who had not completed either type of fellowship had performed a mean of 14.4 procedures per physician per year. In California, the mean annual volume of scoliosis procedures from 1995 to 1999 was 59.0 procedures per year at hospitals with pediatric orthopaedic fellowship programs and 15.7 procedures per year at those with spine surgery programs. The mean number of procedures per fellow at hospitals with pediatric orthopaedic fellowship programs was 31.6 procedures per fellow per year, and the mean number at hospitals with spine surgery programs was 12.7 procedures per fellow per year. Over time, there was a significant increase in the number of procedures per year at hospitals with both types of fellowship programs, but the percentage increase was greater for hospitals with pediatric orthopaedic fellowship programs than for hospitals with spine surgery fellowship programs (45.2% compared with 13.5%). CONCLUSIONS: These data indicate that, on the average, a large number of surgeons in New York performed five scoliosis procedures per year or fewer. Among higher-volume surgeons in New York, those with pediatric orthopaedic fellowship training performed more scoliosis procedures on children and adolescents than those with orthopaedic spine training did. In California, the volume of scoliosis procedures at hospitals with pediatric orthopaedic fellowship programs was nearly four times greater than that at hospitals with spine fellowship programs and the volume of procedures per fellow was more than two times greater, and this disparity is widening over time. These data are an important element in establishing what type of fellowship best prepares surgeons for scoliosis surgery.     

An analysis of vascular surgical manpower requirements and vascular surgical rates in the United States

Inherent in any analysis of vascular surgical manpower must be accurate data on surgical rates and numbers of surgeons who perform vascular operations. For in-depth analysis of age-sex standardized vascular operative rates from 1979 to 1984 and a determination of current manpower levels, data from the National Center for Health Statistics (NCHS) and the American Board of Surgery (ABS) were reviewed. During 1979 to 1984, total vascular surgical procedures increased 50%. In 1983 such operations comprised 11% of all general surgical procedures and 3% of all operations performed in this country. In 1983, 95,000 carotid endarterectomies, 74,000 peripheral bypasses, were performed. Through November 1984, among approximately 1600 surgeons who had applied to take the General Vascular Surgery Examination, 676 took the examination and 545 passed. What percentage of all vascular surgeons these 1600 represent is unknown. Consequently, what percentage of the total vascular operative load their own experiences represent is uncertain. As of May 1985, the Residency Review Committee for General Surgery had approved 42 fellowship positions in 29 vascular training programs. How these training figures will change to meet optimal manpower requirements remains undefined. Although data concerning operative rates have become more precise, forecasting manpower needs will be met with skepticism because of unknown current and future numbers of vascular surgeons and their average caseloads. Regardless of these uncertainties, vascular surgeons, program directors, and health analysts should be aware of such information because until we know how many vascular surgeons are necessary to provide optimal care, training and certification can not rationally evolve.     

Rural versus non-rural differences in surgeon performed endoscopy: results of a national survey

The ongoing decline in the number of general surgeons practicing in rural areas of the United States is concerning. Existing data show that rural surgeons perform a broad spectrum of cases including procedures that are not considered to be in the repertoire of most general surgeons. In particular, rural surgeons seem to be performing a sizeable number of endoscopic procedures. A sixty-item survey was mailed to 1700 rural surgeons while a random sample of 154 urban surgeons were telephoned and administered the same questionnaire. The general surgeons were identified using a list obtained from the American Medical Association Masterfile. The response rate was 25 per cent and 74 per cent among rural and nonrural surgeons respectively. Seventy four per cent of rural surgeons performed more than 50 flexible endoscopies a year in contrast to 33 per cent of nonrural surgeons (P < 0.05). Approximately 42 per cent of rural surgeons reported doing more than 200 procedures annually, whereas only 12 per cent of the nonrural surgeons did so. Additionally, 63 per cent of rural surgeons wished they had further training in endoscopy before starting practice as compared with 46 per cent (P < 0.05) of nonrural surgeons. Rural surgeons perform flexible endoscopy at a much higher rate than their nonrural counterparts. The majority of rural surgeons feel they would have benefited from additional flexible endoscopy training before entering practice.     

Geographic variations in the rates of elective total hip and knee arthroplasties among Medicare beneficiaries in the United States.

We analyzed the variations in the rates of elective total hip and total knee arthroplasties for 1988 in the United States to determine whether the rates correlated with the numbers of surgeons. There were 56,204 total hip arthroplasties and 68,491 total knee arthroplasties, performed in the home states of the patients among all of the Medicare beneficiaries. Medicare beneficiaries include most people who are more than sixty-five years old in the United States and a small proportion of younger people who are eligible for Medicare for other reasons. Seventy-nine per cent of the patients who had had a total hip arthroplasty and 89 per cent of those who had had a total knee arthroplasty had been managed with the operation because of osteoarthrosis. Both operations were most common in the seventy to seventy-four-year age-group. We calculated the rate of operations per 100 beneficiaries for each state and age-adjusted the results. Across all of the states, bilateral procedures constituted 1.6 per cent of the total hip arthroplasties and 4.8 per cent of the total knee arthroplasties. The in-hospital rates of mortality were 0.72 per cent for total hip arthroplasties and 0.45 per cent for total knee arthroplasties. The destinations after discharge from the hospital were similar for the two groups of patients, with more than 65 per cent of the patients being discharged directly to their homes. There were no significant differences among states in terms of the length of stay in the hospital or reimbursement of the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)     

Thoracic surgery manpower: the fourth manpower study of thoracic surgery: 1985 report of the Ad Hoc Committee on Manpower of The American Association for Thoracic Surgery and The Society of Thoracic Surgeons

Responding to a survey about their practice in 1985, 2,969 (70%) Board-certified thoracic surgeons provided data that were compared with data from manpower surveys in 1980 and 1976. (table; see text) Thoracic surgeons were most active between ages 35 and 54 years when they accomplished 61% of all general thoracic and 85% of cardiac operations. Surgeons older than 50 years performed significantly more general thoracic operations than younger surgeons, and the younger group performed significantly more cardiac operations than their older counterparts. Solo practice continued to decline. In smaller referral areas, the number of general thoracic procedures per surgeon increased, but the number of cardiac operations have decreased compared with 1980. Overall, general thoracic and cardiac operations increased, but peripheral vascular procedures and pacemaker insertions decreased in almost all nine census regions. Fewer general thoracic and cardiac operations were performed per thoracic surgeon in the western United States than in central and eastern regions. In response to questions about work load, 55% believed that their clinical activity was satisfactory, 42% operated too little, and 3% operated too much. The 363 non-Thoracic Board-certified surgeons who responded performed 14% of general thoracic and 8% of cardiac surgery in 1985. During the first half of the 1980s, our specialty certified an average of 134 thoracic surgeons annually, which is higher than the 120 surgeons per year estimated to meet the projected demand.     

Rate of and risk factors for acute inpatient mortality after orthopaedic surgery

BACKGROUND: Orthopaedic surgeons operate on a diverse group of patients, and many of these patients have concomitant medical problems. The purpose of this study was to identify the rate of mortality and to evaluate the risk factors associated with mortality after orthopaedic surgery. METHODS: Data from the National Hospital Discharge Survey, a nationwide sample of hospital admissions, were obtained for the years 1995 through 1997. The study was limited to hospital admissions. Univariate and multivariate analyses were performed. RESULTS: The 43,215 inpatient orthopaedic operations that we evaluated were associated with a mortality rate of 0.92%. Seventy-seven percent of all deaths occurred after procedures performed for patients who were more than seventy years old, and 50% of all deaths occurred after operations performed for the treatment of hip fractures. The independent preoperative medical risk factors for death included chronic renal failure, congestive heart failure, metastasis to bone, atrial fibrillation, chronic obstructive pulmonary disease, and osteomyelitis. The risk factors of diabetes, coronary artery disease, peripheral vascular disease, septic arthritis, and rheumatoid arthritis did not achieve significance. Among orthopaedic subspecialty categories, operations for tumors, trauma, and infection were associated with elevated mortality rates. In a predictive model, five critical risk factors were identified as most helpful in identifying patients at risk for death: chronic renal failure, congestive heart failure, chronic obstructive pulmonary disease, hip fracture, and an age of greater than seventy years. The mortality rate was 0.25% for patients with no critical risk factors. A linear increase in mortality was seen with increasing numbers of critical risk factors (p < 0.005). CONCLUSION: Death is rare after orthopaedic operations. In the United States, the rate of acute mortality after inpatient orthopaedic surgical procedures is approximately 1% for all patients, 3.1% for patients with a hip fracture, and 0.5% for patients without a hip fracture. These data will aid orthopaedic surgeons in predicting operative mortality for their patients.     

Revision hip arthroplasty activity in a single UK health region: an audit of 1265 cases

Revision hip arthroplasty is an operation which is steadily increasing in number and can often be technically challenging. We have utilised a regional hip register (the Trent Regional Arthroplasty Study) to analyse the epidemiology of revision hip arthroplasties in a single UK health region. The study shows that of the large number (1265) of procedures performed over a 7-year period (1991-1997), the majority were performed by general orthopaedic surgeons, with 91 different surgeons performing the operation and only two surgeons performing more than 20 procedures per year. Of more than 100 prosthetic combinations used for the procedure, the Charnley prosthesis was the most common (38.3% of acetabular revisions and 37.5% of femoral revisions). The same component was also the most commonly explanted (43%). There was an even geographical spread across the region with revision hip arthroplasty being performed in all hospitals with an orthopaedic in-patient facility. Prospective audit of this large and varied cohort is necessary to determine differences in outcome (if any) between 'specialist' hip surgeons and general orthopaedic surgeons.     

Understanding trends in inpatient surgical volume: vascular interventions, 1980-2000

OBJECTIVE: To help understand past and future trends in vascular intervention, we examined changes in the rate of utilization, patient demographics, and length of stay from 1980 to 2000. METHODS: We reviewed the ICD-9 codes for all vascular procedures using the National Hospital Discharge Survey of non-federal United States hospitals (1980-2000). RESULTS: The number of vascular procedures performed in this country increased from 412,557 in 1980 to 801,537 in 2000 (per capita increase of >50%). This increase was most evident in elderly patients (>75 years, 67% per capita increase in discharges). Long hospital stays (> or =7 days) for vascular procedures fell 41%, and short hospital stays (<24 hours) increased 15% over the period of study. The frequency of abdominal aortic aneurysm repairs remained relatively constant. Except for an interval in the late 1980s, and a minor decrease from 1997 to 2000, the frequency of carotid endartarectomy rose dramatically (69%). Lower extremity revascularizations increased steadily until 1990 but then declined 12%. From 1995 to 2000, there was a 27% per capita decrease in the number of renal-mesenteric operations. Correspondingly, over the past 5 years there has been a 979% growth in the number of percutaneous/endovascular interventions. Despite a substantial number of interventions for lower extremity vascular disease, there was a concomitant increase in the number of major and minor amputations. CONCLUSION: Interventions for vascular disease have increased dramatically, with a major shift toward less invasive treatments, particularly for the renal and mesenteric vessels and the lower extremities. These trends in procedural use suggest that vascular surgeons need to embrace catheter-based approaches if they want to remain leaders in the treatment of peripheral vascular diseases.     

Increased incidence of acute patellar dislocations and patellar instability surgical procedures across the United States in paediatric and adolescent patients

PurposePatellofemoral instability is a common cause of knee pain and dysfunction in paediatric and adolescent patients. The purpose of the study was to evaluate the frequency of patellar dislocations seen in emergency departments (EDs) and the rates of surgical procedures for patellar instability at paediatric hospitals in the United States between 2004 and 2014.MethodsThe Pediatric Health Information System database was queried for all paediatric patients who underwent surgery for patellar instability or were seen in the ED for acute patellar dislocation between 2004 and 2014. This was compared with the annual numbers of overall orthopaedic surgical procedures.ResultsBetween 2004 and 2014, there were 3481 patellar instability procedures and 447 285 overall orthopaedic surgical procedures performed at the included institutions, suggesting a rate of 7.8 per 1000 orthopaedic surgeries. An additional 5244 patellar dislocations treated in EDs were identified. Between 2004 and 2014, the number of patellar instability procedures increased 2.1-fold (95% confidence interval (CI) 1.4 to 3.0), while orthopaedic surgical procedures increased 1.7-fold (95% CI 1.3 to 2.0), suggesting a 1.2-fold relative increase in patellar instability procedures, compared with total paediatric orthopaedic surgeries.ConclusionThis study shows a significant rise in the rate of acute patellar instability treatment events in paediatric and adolescent patients across the country. Surgery for patellar instability also increased over the study period, though only slightly more than the rate of all paediatric orthopaedic surgical procedures. This may suggest that increasing youth sports participation may be leading to a spectrum of increasing injuries and associated surgeries in children.Level of EvidenceIV     

Quality control for cardiac surgery in the Veterans Administration

The volume of cardiac surgical procedures and the 30-day mortality associated with them were reviewed for the total experience of 72 Veterans Administration medical centers over a 10-year period (1975 to 1984). The total number of cardiopulmonary bypass operations increased from 3,074 in 1975 to 6,455 in 1984, whereas operative mortality declined from 8.3 to 4.7%. Operative mortality associated with isolated valve replacement operations declined from 10.9 to 5.9%. Aortocoronary vein bypass operations, which increased in number from 1,679 to 4,988 over the 10-year period, were associated with an operative mortality of 4.7% in 1975 and 3.6% in 1984. The extent of the patient's disease accounted for most of the operative mortality, but problems related to the adequacy of myocardial protection and the surgical technique were also important factors. These data were compared with similar comprehensive statistics compiled by the New York State Department of Health over a five-year period (1979-1983). Operative mortality rates were quite similar for aortocoronary bypass procedures, mitral valve replacements, and total cardiac operations. However, operative mortality for aortic valve procedures was higher among the Veterans Administration hospitals. In the future, if operative risk factors are clearly defined, a more meaningful comparison of operative mortality among ongoing reviews, such as those being carried out by the Veterans Administration and by New York State, could be used to establish standards of performance for cardiac surgery.     

Surgical experience of colon resection in the extreme elderly

A retrospective review was undertaken at Mount Sinai Medical Center of Miami Beach for patients aged 70 and greater undergoing colon resection between January 1, 1983 and December 31, 1983. These resections were performed for carcinoma 67.3 per cent, diverticular disease 10.9 per cent, and other indications 21.8 per cent. The operations were performed by different surgeons with a wide spectrum of procedures and associated simultaneous procedures. The morbidity and mortality were reviewed. Complications occurred in 27.7 per cent (38 complications in 28 patients). The complication rate was highest in those with diverticular disease. The overall mortality rate was 4.95 per cent with a zero mortality in patients undergoing elective colon resections. It would appear that with careful monitoring and avoidance of emergency surgery, colon resection can be safely undertaken in this elderly portion of the population.     

Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery

HYPOTHESIS: An increase in national utilization of bariatric surgery correlates with the dissemination of laparoscopic bariatric surgery. DESIGN: Evaluation of Nationwide Inpatient Sample data from 1998 through 2002. SETTING: National database. PATIENTS: A total of 188,599 patients underwent bariatric surgery for the treatment of morbid obesity. MAIN OUTCOME MEASURES: Annual total number of bariatric operations, the proportion of Roux-en-Y gastric bypass vs gastroplasty, the proportion of laparoscopic cases, postoperative length of stay, crude in-hospital mortality, and the number of institutions that perform bariatric surgery. RESULTS: Between 1998 and 2002, the number of bariatric operations increased from 12,775 cases to 70,256 cases. The rate of bariatric surgery increased from 6.3 to 32.7 procedures per 100,000 adults. Laparoscopic bariatric surgery increased from 2.1% to 17.9%. The number of bariatric surgeons with membership in the American Society for Bariatric Surgery increased from 258 to 631, and the number of institutions that perform bariatric surgery increased from 131 to 323. During this 5-year period, the annual rate of laparoscopic bariatric surgery increased exponentially (by 44-fold) compared with a linear growth in open bariatric surgery (by 3-fold). CONCLUSIONS: Between 1998 and 2002, there was a 450% increase in the number of bariatric operations performed in the United States, a 144% increase in the number of American Society for Bariatric Surgery bariatric surgeons, and a 146% increase in the number of bariatric centers. The growth of laparoscopic bariatric surgery during this 5-year period greatly exceeds that of open bariatric surgery.