The Growing Gap Between the Number of Inpatient and Outpatient Surgeries

In 2008, a group of researchers funded by the World Health Organization (WHO) gathered data from 192 member states of WHO and estimated there were approximately 234 million major surgeries that took place worldwide (Weiser et al., 2008). The general types of surgery can be labeled to the following: ambulatory surgeries, inpatient surgeries, and a more specific kind, organ transplants.

Outpatient surgery, also known as ambulatory surgery, is an operation that is completed within 24 hours, which does not require an overnight hospital stay. Most of these cases are related to eyes, ears, nose, mouth, pharynx, and skin. On the other hand, inpatient surgery is a surgery where the patient must stay in the operating room for more than a day. Most of the cases are related to obstetrical, respiratory, and cardiovascular structures. Urinary, female genital, musculoskeletal, and nervous surgeries were more evenly distributed to both categories (Wier et al., 2012). In the United States, the total number of surgeries at community hospitals increased by 17 percent between 1992 and 2012. In which, there were 17.3 million cases of outpatient surgeries, which is equivalent to 65% of the total surgeries. Whereas a decade before then, outpatient surgeries only made up 54% of the total, approximately equal to 12.3 million (American Hospital Association, 2014).

Figure 1. Ambulatory versus inpatient surgeries by body system in 2012. Retrieve from Wier et al., 2015.

The number of outpatient surgeries has been surpassing that of the inpatient surgeries for the past decade. One of the possible factors that account for this increasing gap could be the specific types of operations that are more frequently performed each category. An infamous example is organ transplant. It is one of most risky types of inpatient surgery, whereas the process may include the removal and the replacement of a failed organ in the body. Not only it is dangerous, the chances of success are very low. Even after the surgery, the organ may not be compatible with the body and cause internal failure (Bioethics, 2004). There was a total of 119,873 transplants worldwide in 2014, and America is the leading country of organ transplants. In 2015, there was a total of 30,970 transplants performed in the U.S. Organ transplants are highly competitive among its recipients. On average, about 80 people receive organ transplants every day but there are still twenty-two people dying daily waiting for an available organ. 95% of the adult Americans supports organ transplant but only half the supporters are registered donors. Currently, there are 119,000 people on the U.S. national transplant waiting list, but the number of available organs is very limited (US. Department of Health & Human Services).

Figure 2. The number of patients on the waiting list, donors, and transplants yearly in the United States. Retrieved from the U.S. Department of Health & Human Services, 2015.

Figure 3. The number of organs transplanted per million population; the United States has the most organ transplant cases worldwide. Retrieved from GODT, 2016.

Over two million surgeries happened annually around the world. Depending on the condition of the patients, physicians and health care workers determine if the patient requires overnight stays at the hospital. The total number of surgeries performed has been increasing since 1992. The  number of inpatient surgeries is increasing with more stability compared to the number of outpatient surgeries. One factor to examine is the limitation of organ transplants held for the past decade. Organ transplant made up approximately 10% of the total surgeries performed in the U.S. The number of patients on the national waiting list for organ transplant is increasing every year, but the number of donors or available/suitable organs are highly restricted. There wasn’t a clear increase either in the number of donors or transplants for the last 12 years (figure 3). The restricted limit on the available resources provided for this type of surgery can be a great factor contributing to the steady increase in the number of inpatient surgeries.

Literature cited

American Hospital Association. (2014). Utilization and volume. In: Trends Affecting Hospitals and Health Systems, chapter 3. http://www.aha.org/research/reports/tw/chartbook/index.shtml.

Center for Bioethics. (2004). Ethics of Organ Transplantation. University of Minnesota’s center for bioethics.

Global Observatory on Donation and Transplant (GODT). (2016). WHO-ONT. WHO Collaborating Centre on Donation and Transplantation.

U.S. Department of Health & Human Services, Health Resources & Services Administration. (2015). Organ Donation Statistics. U.S. Government Information on Organ Donation and Transplantation.

Weiser, G.T., Regenbogen, S.E., Thompson, K.D., Haynes, A.B., Lipsitz, S.R., Berry, W.R., and Gawande, A.A. (2008). An estimation of the global volume of surgery: a modeling strategy based on available data. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA

Wier, L.M., Steiner, C.A., and Owens, P.L. (2015). Surgeries in Hospital-Owned Outpatient Facilities, 2012. Healthcare Cost and Utilization Project.