Series 13

No. 124

Trends in Hospital Utilization:

United States, 1988–92

June 1996

Vital and

Health Statistics

From the CENTERS FOR DISEASE CONTROL AND PREVENTION / National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics
Copyright information

All material appearing in this report is in the public domain and may be

reproduced or copied without permission; citation as to source, however, is

appreciated.

Suggested Citation

Gillum BS, Graves EJ, Kozak LJ. Trends in hospital utilization: United States

1988–92. National Center for Health Statistics. Vital Health Stat 13(124). 1996.

Library of Congress Catalog Card Number

Gillum, Brenda.

Trends in hospital utilization : United States, 1988–92 / [B.S. Gillum, E.J.

Graves, L.J. Kozak].

p. cm. — (Vital and health statistics. Series 13, Data from the national

health survey ; no. 124) (DHHS publication ; no. (PHS) 96-1785)

ISBN 0-8406-0516-1

1. Hospital utilization—United States—Statistics. I. Graves, Edmund. II.

Kozak, Lola Jean. III. National Center for Health Statistics (U.S.) IV. Title. V.

Series. VI. Series: DHHS publication ; no. (PHS) 96-1785.

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Trends in Hospital Utilization:

United States, 1988–92

Series 13:

Data From the National Health

Survey

No. 124

This report presents statistics on the utilization of non-Federal short-stay

hospitals based on data collected through the National Hospital Discharge

Survey for the years 1988 through 1992. The survey is a national sample of

hospital records of discharged patients. Estimates are provided by the

demographic characteristics of patients discharged, by geographic region

of hospitals, and by selected conditions diagnosed and procedures

performed. Measurements of hospital use include frequency, rate, percent,

and average length of stay.

Hyattsville, Maryland

June 1996

DHHS Publication No. (PHS) 96-1785

Vital and

Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics
National Center for Health Statistics

Edward J. Sondik, Ph.D. Director

Jack R. Anderson, Deputy Director

Jacob J. Feldman, Ph.D., Associate Director for Analysis,

Epidemiology, and Health Promotion

Gail F. Fisher, Ph.D., Associate Director for Planning and

Extramural Programs

Jack R. Anderson, Acting Associate Director for

International Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Monroe G. Sirken, Ph.D., Associate Director for Research

and Methodology

Division of Health Care Statistics

W. Edward Bacon, Ph.D., Director

Thomas McLemore, Deputy Director

Robert Pokras, Chief, Hospital Care Statistics Branch

Manoochehr K. Nozary, Chief, Technical Services Branch

Cooperation of the U.S. Bureau of the Census

Under the legislation establishing the National Health Survey, the Public Health

Service is authorized to use, insofar as possible, the services or facilities of other

Federal, State, or private agencies.

In accordance with specifications established by the National Center for Health

Statistics, the U.S. Bureau of the Census, under a contractual arrangement, participated

in planning the survey and collecting the data.
Contents

Introduction............................................................................................. 1

Highlights .............................................................................................. 2

Methods................................................................................................ 3

Hospital utilization ....................................................................................... 6

Utilization by sex ........................................................................................ 8

Utilization by region...................................................................................... 9

Utilization by diagnosis and sex ........................................................................... 10

Utilization of procedures by sex ........................................................................... 13

Utilization of selected sex-specific procedures ................................................................ 14

Utilization of selected heart-related procedures by sex ......................................................... 16

Summary .............................................................................................. 18

References............................................................................................. 19

List of detailed tables.................................................................................... 21

Appendixes

I. Technical notes on methods .......................................................................... 55

II. Definitions of terms ................................................................................ 67

III. Recent publications from the National Hospital Discharge Survey ........................................... 70

Text tables

A. Crude and age-adjusted rates of discharges from short-stay hospitals by first-listed diagnosis of malignant neoplasm

or pneumonia and sex: United States, 1988–92............................................................ 4

B. Crude and age-adjusted rates of cardiac catheterizations and diagnostic ultrasounds for discharges from short-stay

hospitals by sex: United States, 1988–92 ................................ ................................ 4

C. Median age of discharges from short-stay hospitals and the U.S. civilian population: United States, 1980, 1985, and

1988–92 ............................................. ............................................. 6

D. Number and percent distribution of newborn infants discharged from short-stay hospitals by length of stay and

average length of stay by health status: United States, 1980, 1985, and 1988–92 ................ ................ 7

E. Number of discharges from short-stay hospitals, days of care, and average length of stay, by selected first-listed

diagnoses: United States, 1988 and 1992................................................................ 10

F. Number and rate of male discharges from short-stay hospitals by selected first-listed diagnoses: United States, 1988

and 1992.......................................................................................... 11

G. Number and rate of female discharges from short-stay hospitals by selected first-listed diagnoses: United States,

1988 and 1992 .......................................... .......................................... 11

List of text figures

1. Crude and age-adjusted rates of discharges with a first-listed diagnosis of malignant neoplasm or pneumonia: United

States, 1988–92 .......................................... .......................................... 5

2. Crude and age-adjusted rates of diagnostic ultrasounds and cardiac catheterizations: United States, 1988–92 ..... ..... 5

iii
3. Rate of discharges by sex: United States, 1988–92 ............................ ............................ 8

4. Rate of days of care by sex: United States, 1988–92 ........................... ........................... 8

5. Average length of stay by sex: United States, 1988–92...................................................... 8

6. Rate of discharges by region: United States, 1988–92 ...................................................... 9

7. Average length of stay by region: United States, 1988–92 ......................... ......................... 9

8. Rate of hysterectomies for females by age: United States, 1988–92 ..................... ..................... 14

9. Rate of cesarean sections for females by age: United States, 1988–92 .................... .................... 14

10. Rate of prostatectomies for males aged 65–74 years and 75 years and over: United States, 1988–92 ....... ....... 15

11. Percent of male newborn infants circumcised by region: United States, 1988–92 ............... ............... 15

12. Rate of open heart surgery by sex: United States, 1988–92 ........................ ........................ 16

13. Rate of removal of coronary artery obstructions by sex: United States, 1982–92................................ 16

14. Rate of discharges with one or more coronary artery bypass grafts by sex: United States, 1988–92 ........ ........ 16

15. Rate of cardiac catheterizations by sex: United States, 1988–92 ...................... ...................... 17

iv
Trends in Hospital

Utilization: United States,

1988–92

by Brenda S. Gillum, Edmund J. Graves, and Lola Jean

Kozak, Division of Health Care Statistics

Introduction

The National Hospital Discharge Survey (NHDS) has

been conducted annually since 1965. Hospital utilization statistics from the NHDS are routinely published by the National

Center for Health Statistics for individual years. Because

almost 30 years of data are available, there is much demand

for NHDS data on trends in hospital use. Some trend data have

been included in previous NHDS reports. In addition, a

detailed description of trends in hospital utilization from 1965

through 1986 was presented in a previous report (1). The

purpose of this report is to present general statistics from 1988

through 1992 on hospital utilization by patient characteristics,

geographic region, and selected diagnoses and procedures.

The period beginning with 1988 was chosen for this

report because that was the first year a new design was used

for the NHDS (see methods section). Estimates based on this

new design could differ from those based on the 1965–87

design due to changes in the survey rather than actual changes

in hospital utilization. Because 1988–92 data are all from the

same survey design, trends for this period are not affected by

design effects.

However, many users of NHDS data are interested in a

longer perspective on hospital use than can be seen in 5 years

of data. For historical information, estimates for 1980 and

1985 are included in most of the tables in this report. Because

hospital use trends during the first half of the 1980’s were

discussed in depth in an earlier report (1), they will not be

discussed again here.

Data from the National Hospital Discharge Survey are

used to examine a wide array of health issues. Topics such as

morbidity from cerebrovascular disease, the frequency of

vaginal births after previous cesarean section delivery (VBAC),

and hospital use for cardiovascular disease have been studied

using NHDS data (2–5). Trend analyses of NHDS data on

HIV, hysterectomy, diabetes, and obstetrical procedures have

been published (6–10). NHDS data are used to track objectives related to the 22 priority areas targeted in Healthy People

2000 (11), including objectives on unintentional injuries,

environmental health, maternal and infant health, diabetes and

chronically disabling conditions, and sexually transmitted diseases. Data for several of these topics are shown in the

numbered tables.

This report is organized into several sections. The methods section briefly describes the survey design and discusses

issues related to the production of the statistics shown in the

tables A–G and 1–32 and figures 1–15. The methods section is

followed by sections that present selected findings by sex,

region, diagnoses, and procedures. Detailed tables are shown

after the text. The appendixes describe technical aspects of the

survey (appendix I), definitions of terms (appendix II), and

recent NCHS publications of data from the National Hospital

Discharge Survey (appendix III).

The 32 numbered tables show hospital utilization data for

1980, 1985, and 1988–92. Trend data are presented by age and

sex (tables 1–3), by age and region (tables 4–6), by hospital

deaths (table 7), by selected diagnoses by sex (tables 8–16), by

discharges with procedures (table 17), and by selected procedures by sex (tables 18–23). Trends in the use of selected

sex-specific procedures are shown in tables 24–28. These

include hysterectomy, cesarean section and other obstetrical

procedures, prostatectomy, and circumcision. Tables 29–32

present trend data by age and sex for selected heart-related

procedures. This includes open heart surgery, removal of

coronary artery obstruction, coronary artery bypass graft, and

cardiac catheterizations.

ACKNOWLEDGMENTS: This report was prepared in the Division of Health Care

Statistics. Lester Curtin and Iris Shimizu, Office of Research and Methodology, provided

methodological advice. Maria Owings, Hospital Care Statistics Branch, provided specific

standard errors used in statistical tests. Virginia Freid and Deborah Ingram, Office of

Analysis, Epidemiology, and Health Promotion, were the peer reviewers. The report was

edited by Klaudia Cox and typeset by Annette F. Holman, Division of Data Services.

1
Highlights

+ The rate of discharges did not change significantly between

1988 and 1992, but the rate of days of care declined

10 percent.

+ The average length of stay declined 6 percent for both

males and females from 1988 to 1992.

+ Deliveries, heart disease, and malignant neoplasms were

common reasons for hospitalization and represented

approximately 30 percent of first-listed diagnoses in 1988

and 1992.

+ Each year from 1988 to 1992, episiotomy, arteriography

and angiocardiography using contrast material, computerized axial tomography (CAT scan), diagnostic ultrasound,

and fetal EKG and other fetal monitoring were each

performed over 1 million times on hospital inpatients.

+ In 1992, 61 percent of male newborn infants were circumcised before they were discharged from the hospital; the

proportion circumcised ranged from 38 percent in the

West to 78 percent in the Midwest.

+ The rate for removal of coronary artery obstruction

increased 57 percent for males and 96 percent for female

discharges from 1988 to 1992.

+ Males accounted for 67 percent of four heart-related procedures (open heart surgeries, removal of coronary obstruction, coronary artery bypass graft, and cardiac

catheterizations) performed in 1988, and 65 percent in

1992.

2
Methods

Data for the National Hospital Discharge Survey (NHDS)

come from a sample of inpatient records obtained from a

national sample of non-Federal general and short-stay specialty hospitals in the United States. Information concerning

the universe from which the sample is drawn, sample size,

response rate, and number of medical abstracts collected for

each data year shown in this report, is in appendix I.

NHDS data have been collected continuously since 1965.

The original sample was selected from a frame of short-stay

hospitals listed in the 1963 National Master Facility Inventory

of Hospitals. The frame and sample were updated periodically

to include newly opened hospitals. Beginning in 1988, the

NHDS was redesigned and a new sample of hospitals was

selected. Differences between NHDS statistics based on the

1965–87 sample and statistics based on the new sample may

be due to sample design rather than to real changes in hospital

use patterns. A brief description of the sample design and

survey methods is in appendix I. Detailed reports on the

original design of the NHDS and on a comparison between the

two designs have been published (12,13).

The frame of hospitals for the redesigned survey was

based on hospitals contained in the April 1987 SMG Hospital

Market Database (14). Only hospitals accepting inpatients by

August 1987 were included. The definition of hospitals in the

NHDS was modified slightly in the redesign. Prior to 1988,

hospitals with an average length of stay of 30 days or more

were excluded. Beginning in 1988, general medical and

surgical and children’s general hospitals were included regardless of the overall average length of stay of the inpatient

population. However, the term ‘‘short-stay’’ continues to be

used because 98 percent of hospitals in the NHDS universe

fall into this category. In 1991, the frame and sample were

updated to include hospitals from the 1991 SMG Hospital

Database (15).

Medical data for hospitalized patients are coded according

to the International Classification of Diseases, 9th Revision,

Clinical Modification, or ICD–9–CM (16). A maximum of

seven diagnoses and four procedures are coded from the

medical record for each discharge in the sample. Although

diagnoses included in the ICD–9–CM section, ‘‘Supplementary classification of external causes of injury and poisoning,’’

(coded E800–E999) are collected in the NHDS, these diagnoses are excluded from the report. Beginning October 1,

1986, annual addenda to the ICD–9–CM have been published.

They add, delete, or change diagnostic and procedure codes or

their titles. Changes in codes that affect diagnostic or procedure categories in this report are discussed in appendix I.

Data for newborn infants are shown in tables D and 28.

Because these data are based on a sample of hospital births,

they may not agree with data on births published in the

Monthly Vital Statistics Report and Vital Statistics of the

United States, which report all births.

Tables 1–6 contain numbers, age-specific rates, and ageadjusted rates for discharges and days of care, and age-specific

and age-adjusted average lengths of stay. Age-adjustment was

computed using the direct method (17) with the 1980 civilian

population, as described in appendix II. Age-adjusted average

stays shown in tables 3 and 6 were computed by dividing the

adjusted days of care by the adjusted number of discharges.

Because the age distribution of the population did not change

substantially in the 5-year period 1988–92 that is the focus of

this report, crude (unadjusted) rates and average lengths of

stay were used in the weighted regression analysis and are

shown in tables 7–32 and figures 1–15.

Researchers wanting to eliminate the effects of differences

in the age structure of the population when comparing rates

can age-adjust rates using a standard population. Tables A and

B and figures 1 and 2 show examples of crude and ageadjusted rates for two diagnoses and two procedures, respectively. In these tables, the crude rate is the number of

discharges or procedures divided by the midyear population,

expressed as a rate per 10,000 or per 100,000 population. To

age-adjust, rates for specific diagnoses or procedures were

computed for four age groups (under 15 years, 15–44 years,

45–64 years, and 65 years and over) of both sexes. These

age-specific rates were multiplied by the standard population

(see appendix II) for the corresponding age group and summed.

The sum was divided by the total standard population to

produce an age-adjusted rate. Age-specific data needed to

compute age-adjusted rates are available in NHDS publications (see appendix III) or from the NHDS. Crude rates, which

reflect the actual frequency of hospital use, should not be

compared with age-adjusted rates. However, one can compare

age-adjusted rates to control for differences in age distributions by year, region, race, sex, or other variables. Further

discussion of age-adjustment is available in Healthy People

2000 Statistical Notes (18).

Table 7 shows the estimated numbers of hospital deaths

and hospital fatality rates for selected conditions. A hospital

fatality rate is the number of stated deaths for a category of

3
first-listed diagnoses, divided by the total number of discharges for that category, and multiplied by 100. This rate is

conservative because the formula is based on the assumption

that all patients whose discharge status was not stated were

discharged alive. The hospital fatality rate differs from the

mortality rate, which reflects complete reporting of deaths

regardless of where the death occurred. In addition to being a

100 percent enumeration of deaths, mortality data are for the

underlying cause of death, which may not be identical to the

first-listed diagnosis. Mortality rates are regularly published

by NCHS in the Monthly Vital Statistics Report and in the

Vital Statistics of the United States.

The conditions diagnosed and procedures performed

appearing in tables 8–16 and 18–23 are the same categories

shown in the 1990–93 NHDS annual summaries published in

Advance Data From Vital and Health Statistics and series 13

of Vital and Health Statistics. Data for a more detailed list of

ICD–9–CM codes are in the annual report, ‘‘Detailed Diagnoses and Procedures, National Hospital Discharge Survey,’’

also published in series 13 of Vital and Health Statistics.

The number of discharges with procedures in table 17 and

the total number of procedures per year in tables 18–23 were

affected by changes in NHDS coding practices. As described

in appendix II, not all procedures were coded when the

ICD–9–CM was first used for the 1979 NHDS data. Additional procedures began to be coded in the 1983 and 1989

NHDS, and beginning with the 1991 data, all the ICD–9–CM

codes were used. In addition, the number of discharges with

surgical procedures in table 17 was affected by a revision in

the classification of procedures as surgical or nonsurgical. This

Table A. Crude and age-adjusted rates of discharges from short-stay hospitals by first-listed diagnosis of malignant neoplasm or

pneumonia and sex: United States, 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic categories and code numbers are based on the International Classification

of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Diagnosis and ICD–9–CM code

Crude rates Age-adjusted rates1

Total Male Female Total Male Female

Malignant neoplasm, 140–208,230–234 Rate per 10,000 population

1988 ................................ 68.8 65.7 71.7 67.0 70.7 66.0

1989 ................................ 65.6 64.8 66.3 63.4 69.6 60.1

1990 ................................ 63.4 60.8 65.9 61.4 64.9 60.3

1991 ................................ 63.6 64.3 63.0 61.2 68.5 56.7

1992 ................................ 62.2 62.2 62.3 59.4 65.5 56.0

Pneumonia, 480–486

1988 ................................ 38.1 40.2 36.1 37.0 42.5 33.0

1989 ................................ 42.2 45.8 38.7 40.8 48.1 35.3

1990 ................................ 42.5 44.1 40.9 40.9 46.1 37.0

1991 ................................ 43.4 44.8 42.1 41.6 46.8 37.9

1992 ................................ 41.8 43.5 40.1 39.9 45.0 35.9

1See appendix II for method of computation.

Table B. Crude and age-adjusted rates of cardiac catheterizations and diagnostic ultrasounds for discharges from short-stay hospitals,

by sex: United States, 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Groupings of procedures and code numbers are based on the International

Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Procedure category and ICD–9–CM code

Crude rates Age-adjusted rates1

Total Male Female Total Male Female

Cardiac catheterizations, 37.21–37.23 Rate per 100,000 population

1988 ................................ 382.9 508.4 265.2 379.1 542.3 243.3

1989 ................................ 390.7 506.1 282.3 384.6 538.1 256.5

1990 ................................ 401.8 515.8 294.5 395.4 548.0 268.7

1991 ................................ 399.2 496.0 307.9 391.2 526.3 277.5

1992 ................................ 405.6 517.1 300.4 391.4 541.9 265.7

Diagnostic ultrasound, 88.7

1988 ................................ 643.2 509.3 768.9 626.8 538.4 715.6

1989 ................................ 635.7 528.8 736.1 618.8 557.1 685.0

1990 ................................ 649.2 555.3 737.6 627.6 584.9 677.1

1991 ................................ 635.2 536.2 728.5 612.6 564.0 668.7

1992 ................................ 575.2 477.2 667.6 552.0 497.9 607.6

1See appendix II for method of computation.

4
became effective with 1989 NHDS data. This revision is also

discussed in appendix II. Tables 18–23 present estimates for

all-listed procedures. That is, all occurrences of a procedure

are counted, regardless of the order, up to a maximum of four

procedures per discharge.

Table 25 contains trend data on obstetrical procedures for

females with deliveries. Rates for some obstetric procedures

are shown per 100 deliveries. Rates for other obstetric procedures are shown per 100 vaginal deliveries because these

procedures are not expected to be done for women who had

cesarean delivery. In addition to NHDS data, information on

deliveries (e.g., obstetric procedures and pregnancy complications) is obtained from birth certificates and published by

NCHS in the Monthly Vital Statistics Report, and Vital Statistics of the United States.

The estimates in table 31 are for discharges with at least

one coronary artery bypass graft (CABG)(ICD–9–CM code

36.1). A surgeon may perform more than one CABG procedure during a single operation. For example, in 1992, a total of

468,000 CABG procedures (table 18) were performed on

309,000 discharges (table 31). Thus, the number of CABG

procedures should not be equated with the number of patients

having the procedure.

The rates presented in this report are based on estimates

of the civilian population as revised by the U.S. Bureau of the

Census after the 1990 census. These rates differ somewhat

from rates in previous NCHS publications, which were based

on earlier population estimates from the U.S. Bureau of the

Census. However, as shown in appendix I, the differences

between previously published rates and the rates in this report

are small.

Weighted linear regression was used to analyze trends for

selected variables. Specific standard errors for rates analyzed

in the regression were produced using the SUDAAN program

(19). See appendix I for a detailed explanation of the techniques used for weighted regression.

Familiarity with the definitions used in the NHDS is

important for interpreting the data and for making comparisons with data on hospital utilization available from other

sources. Definitions of terms used in this report are presented

in appendix II.

Information on short-stay hospital utilization also is collected in another program of NCHS, the National Health

Interview Survey (NHIS). Estimates from this survey generally differ from those of the NHDS because of differences in

collection procedures, the population sampled, and definitions.

Data from the NHIS are published in series 10 of Vital and

Health Statistics.

1988 1989 1990 1991 1992

0

30

35

40

45

50

55

60

65

70

75

80

85

Rate per 10,000 population

Malignant neoplasm

Pneumonia

Crude rates Age-adjusted rates

Figure 1. Crude and age-adjusted rates of discharges with a

first-listed diagnosis of malignant neoplasm or pneumonia:

United States, 1988–92

1988 1989 1990 1991 1992

0

300

350

400

450

500

550

600

650

700

750

800

850

Rate per 100,000 population

Cardiac catheterizations

Diagnostic ultrasounds

Crude rates Age-adjusted rates

Figure 2. Crude and age-adjusted rates of diagnostic ultrasounds

and cardiac catheterizations: United States, 1988–92

5
Hospital utilization

The focus of the report is hospital utilization from 1988 to

1992 as measured by data from the National Hospital Discharge Survey. Estimates of hospital use in 1980 and 1985 are

included in the tables to provide a broader historical perspective.

A previous report on trends in hospital utilization discussed the dramatic rise of hospital discharges and days of

care in the 1970’s and their decline in the 1980’s due to major

influences from technology, an aging population, and health

care policy (1). One of the strongest influences on hospital use

in the late 1980’s and 1990’s was the growth of outpatient

surgery. Patients who previously would have been hospitalized

were undergoing surgery and returning home the same day.

According to the American Hospital Association (AHA), the

rise in outpatient surgery was facilitated by the development

of new technologies, such as endoscopic techniques, and new

anesthetic drugs that allow patients to wake up more quickly

after surgery, as well as changes in reimbursement policy that

promote outpatient surgery (20).

Outpatient or ambulatory surgeries are performed in freestanding or hospital-based ambulatory surgery centers. In

1988, 1.7 million surgical procedures were performed in

approximately 980 free-standing ambulatory surgical centers

(FASC’s) in the United States (21). In 1993, this number had

grown to 3.2 million surgical procedures performed in approximately 1,860 FASC’s. However, the majority of outpatient

surgeries occur in hospitals. Ambulatory surgeries in these

hospitals increased from 10.6 million in 1988 to 12.8 million

in 1992 for AHA-registered hospitals (21). Outpatient surgeries done in either hospitals or free-standing surgical centers

are not included in the NHDS nor in this report because only

hospital inpatients are within the scope of the survey. Additional information about the use of ambulatory surgery centers

is being gathered in the National Survey of Ambulatory

Surgery begun in 1994 by the National Center for Health

Statistics.

In addition to the growth of ambulatory surgery, the aging

of the U.S. population continues to influence inpatient hospital

use. As shown in table C, the median age of the civilian

population was 30.1 years of age in 1980, 32.3 years in 1988,

and 33.5 years in 1992. The median age for hospital discharges was 43.9 years in 1980, 48.5 years in 1988, and 50.7

years in 1992. The aging of the hospital population also can be

seen in tables 1 and 2. In 1980, persons 45 years and over

accounted for 49 percent of total discharges and 64 percent of

the days of care. In 1992, persons 45 years and over made up

56 percent of the discharges and 68 percent of the days of care

(tables 1 and 2).

Changing health care policies also affect hospital utilization. A recent example is the efforts by managed-care plans

and other insurers to shorten hospital stays for women after

delivery and for their newborn infants (22–24). Table D shows

the trends in lengths of stay for newborn infants. In 1980,

31 percent of newborn infants stayed in the hospital 2 days or

less, and 63 percent stayed 3 to 7 days. In 1988, 55 percent of

newborn infants had hospital stays of 2 days or less, and

41 percent stayed 3–7 days. By 1992, 66 percent of newborn

infants were hospitalized for 2 days or less and only 29 percent had stays of 3–7 days.

Table C. Median age of discharges from short-stay hospitals and

the U.S. civilian population: United States, 1980, 1985, and

1988–92

Year

Hospital

discharges1

U.S. civilian

population2

Median age in years

1980 ............... 43.9 30.1

1985 ............... 46.6 31.5

1988 ............... 48.5 32.3

1989 ............... 48.4 32.6

1990 ............... 48.9 32.9

1991 ............... 49.0 33.2

1992 ............... 50.7 33.5

1Discharges of inpatients from non-Federal hospitals excluding newborn infants.

2Based on population estimates consistent with Series P-25, Current Population Reports,

U.S. Bureau of the Census.

6
Table D. Number and percent distribution of newborn infants discharged from short-stay hospitals by length of stay and average length

of stay by health status: United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals]

Length of stay or health status 1980 1985 1988 1989 1990 1991 1992

Number in thousands

All newborn infants ................ 3,824 3,794 3,733 3,884 3,869 3,880 3,689

Less than 1 day . . . . . . . . . . . . . . . . . . 69 84 72 89 79 81 73

1 day . . . . . . . . . . . . . . . . . . . . . . . . . 270 428 531 596 693 779 873

2 days . . . . . . . . . . . . . . . . . . . . . . . . 842 1,057 1,436 1,601 1,624 1,612 1,506

3 days ........................ 1,175 1,034 704 649 636 658 632

4 days . . . . . . . . . . . . . . . . . . . . . . . . 618 528 502 485 447 385 284

5–7 days . . . . . . . . . . . . . . . . . . . . . . 633 497 329 298 232 198 161

8 days or more . . . . . . . . . . . . . . . . . . 218 167 159 166 157 167 160

Percent distribution

All newborn infants ................ 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Less than 1 day . . . . . . . . . . . . . . . . . . 1.8 2.2 1.9 2.3 2.0 2.1 2.0

1 day . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 11.3 14.2 15.3 17.9 20.1 23.7

2 days ........................ 22.0 27.9 38.5 41.2 42.0 41.5 40.8

3 days ........................ 30.7 27.3 18.9 16.7 16.4 17.0 17.1

4 days ........................ 16.2 13.9 13.4 12.5 11.6 9.9 7.7

5–7 days ...................... 16.6 13.1 8.8 7.7 6.0 5.1 4.4

8 days or more . . . . . . . . . . . . . . . . . . 5.7 4.4 4.3 4.3 4.1 4.3 4.3

Average length of stay in days

All newborn infants . . . . . . . . . . . . . . . . 4.3 3.8 3.5 3.4 3.3 3.2 3.1

Well1 . . . . . . . . . . . . . . . . . . . . . . . . . 3.2 2.8 2.5 2.4 2.3 2.3 2.0

Sick2 . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 5.7 4.9 4.8 4.8 4.6 4.7

1Without any illness or risk-related diagnoses.

2With at least one illness or risk-related diagnosis.

7
Utilization by sex

The number of discharges from short-stay hospitals was

approximately 31 million in both 1988 and 1992. Weighted

linear regression was used to analyze trends in discharge rates,

rates of days of care, and average length of stay from 1988 to

1992. The rate of discharges per 1,000 population did not

change significantly during this period; it was 128.3 in 1988

and 122.1 in 1992. However, the rate of days of care per 1,000

population declined 10 percent, from 838.8 in 1988 to 751.0 in

1992. The average length of stay declined 5 percent from 1988

(6.5 days) to 1992 (6.2 days). Tables 1–3 present numbers and

rates of discharges and days of care, and average lengths of

stay, by age and sex.

+ Discharge rates for males and females did not change

significantly from 1988 to 1992 (figure 3). Males had

107.5 discharges per 1,000 population in 1988 and 100.8

in 1992. For females, the discharge rates were 147.7 in

1988 and 142.2 in 1992.

+ Males accounted for approximately 40 percent (12 to 13

million) of total discharges in 1988 and 1992. Females had

about 19 million discharges in both these years. Over

10 percent of all discharges in 1988 and 1992 were for

females with deliveries (see section on utilization by

diagnosis and sex).

+ Rates of days of care per 1,000 population declined

significantly for males and females from 1988 to 1992

(figure 4). For males, the rate declined 11 percent from

760.7 in 1988 to 679.7 in 1992. For females, there was a

10 percent decrease, from 912.1 in 1988 to 818.3 in 1992.

+ In both 1988 and 1992, males accounted for 44 percent of

days of care and females used 56 percent of days of care.

+ The average stay for males declined 6 percent from 7.1

days in 1988 to 6.7 days in 1992. For females, the average

length of stay also declined 6 percent from 6.2 days in

1988 to 5.8 days in 1992 (figure 5).

1988 1989 1990 1991 1992

0

100

110

120

130

140

150

160

Rate per 1,000 population

Female

Male

Figure 3. Rate of discharges by sex: United States, 1988–92

1988 1989 1990 1991 1992

0

700

750

800

850

900

950

1,000

Rate per 1,000 population

Male

Female

650

Figure 4. Rate of days of care by sex: United States, 1988–92

1988 1989 1990 1991 1992

0

6.0

6.5

7.0

7.5

Average length of stay in days

Male

Female

5.5

Figure 5. Average length of stay by sex: United States, 1988–92

8
Utilization by region

Weighted linear regression analysis of the rates of discharges and days of care showed that these rates did not

change significantly from 1988 to 1992 for any of the four

geographic regions of the country. Tables 4–6 present hospital

utilization data by age and region. Regional trends in discharge rates are shown in figure 6, and average lengths of stay

by region are displayed in figure 7.

+ In 1988, discharge rates per 1,000 population ranged from

107.4 per 1,000 population in the West to 140.3 in the

Northeast. In 1992 the range was from 99.5 in the West to

139.9 in the Northeast.

+ Rates of days of care per 1,000 population ranged from

624.3 in the West to 1,081.0 in the Northeast in 1988 and

from 513.9 in the West to 1,005.1 in the Northeast in 1992.

+ Average lengths of stay varied from 5.8 days in the West

to 7.7 days in the Northeast in 1988 and from 5.2 days in

the West to 7.2 days in the Northeast in 1992.

+ In 1988, 35 percent of discharges were in the South,

25 percent were in the Midwest, 23 percent were in the

Northeast, and 17 percent were in the West. The percents

for 1992 were 36 percent of discharges in the South,

23 percent in the Midwest, 23 percent in the Northeast,

and 18 percent in the West.

+ In 1988 and 1992, persons 45 years of age and over used

two-thirds or more of days of care in the Northeast,

Midwest, and South, but 55–62 percent of the days of care

in the West.

1988 1989 1990 1991 1992

0

100

105

110

115

120

125

130

135

140

145

150

Rate per 1,000 population

Midwest

South

Northeast

West

95

Figure 6. Rate of discharges by region: United States, 1988–92

1988 1989 1990 1991 1992

0

5.5

6.0

6.5

7.0

7.5

8.0

8.5

Average length of stay in days

Northeast

Midwest

South

West

5.0

Figure 7. Average length of stay by region: United States,

1988–92

9
Utilization by diagnosis and

sex

Hospital use measures for selected first-listed diagnoses

are shown in table E. The categories shown accounted for half

or more of all discharges and days of care in 1988 and 1992.

Table F lists the diagnostic categories with 200,000 or more

male discharges in 1988 or 1992. These categories made up

nearly half of male discharges. Diagnostic categories with

200,000 or more female discharges in 1988 or 1992 are in

table G, and these categories include more than half of female

discharges. Diagnostic data in tables E–G and table 7 are

highlighted below. Additional diagnostic data are in tables

8–16.

+ Heart disease was the first-listed diagnosis for 12 percent

(3.6 million) of discharges in 1988 and 13 percent (3.9

million) in 1992. These discharges had an average length

of stay of 7.1 days in 1988 and 6.7 days in 1992. They

used 13–14 percent of total days of care, and made up

23 percent of hospital deaths.

+ Females hospitalized for deliveries accounted for 12 percent (3.8 million) of first-listed diagnoses in 1988 and

13 percent (3.9 million) in 1992. Because their average

lengths of stay were short—2.9 days in 1988 and 2.6 days

in 1992—females with deliveries made up only 5 percent

of the total days of care.

+ Malignant neoplasms (cancers) were first-listed diagnoses

for 5 percent of discharges in 1988 and 1992. These

discharges used 7–8 percent of total days of care and had

Table E. Number of discharges from short-stay hospitals, days of care, and average length of stay, by selected first-listed diagnoses:

United States, 1988 and 1992

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic categories and code numbers are based on the International Classification

of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Diagnosis and ICD–9–CM codes

Discharges Days of care

Average length

of stay

1988 1992 1988 1992 1988 1992

Number in thousands Days

All conditions1 .................................... 31,146 30,951 203,678 190,386 6.5 6.2

Heart disease ...... 391–392.0,393–398,402,404,410–416,420–429 3,641 3,935 25,883 26,256 7.1 6.7

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . 410 716 747 6,432 6,058 9.0 8.1

Coronary atherosclerosis ........................ 414.0 411 416 2,502 2,342 6.1 5.6

Other ischemic heart disease . . . . . . . . . . . 411–413,414.1–414.9 921 971 4,871 4,831 5.3 5.0

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 491 542 2,758 2,835 5.6 5.2

Congestive heart failure ......................... 428.0 634 822 5,560 6,506 8.8 7.9

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . V27 3,781 3,910 11,029 10,040 2.9 2.6

Malignant neoplasms .................... 140–208,230–234 1,670 1,577 15,676 13,433 9.4 8.5

Pneumonia ................................ 480–486 924 1,059 7,801 8,793 8.4 8.3

Fractures ................................. 800–829 1,014 1,016 8,558 7,842 8.4 7.7

Psychosis ................................. 290–299 781 908 11,812 11,746 15.1 12.9

Cerebrovascular disease ....................... 430–438 784 829 7,611 7,302 9.7 8.8

Arthropathies and related disorders ................. 710–719 459 554 3,416 4,027 7.4 7.3

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 484 512 3,162 2,236 6.5 4.4

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 454 476 3,734 3,274 8.2 6.9

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 479 463 2,279 2,008 4.8 4.3

Benign neoplasms and neoplasms of uncertain behavior and

unspecified nature ..................... 210–229,235–239 428 422 2,117 1,947 4.9 4.6

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . 722 417 407 2,466 1,786 5.9 4.4

Acute respiratory infection ....................... 460–466 445 376 2,282 1,495 5.1 4.0

1Includes data for diagnostic conditions not shown in table.

NOTE: This table includes diagnostic categories that accounted for 400,000 or more discharges in 1988 or 1992.

10
Table F. Number and rate of male discharges from short-stay hospitals by selected first-listed diagnoses: United States, 1988 and 1992

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic categories and code numbers are based on the International Classification

of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Diagnosis and ICD–9–CM codes 1988 1992 1988 1992

Number in

thousands

Rate per

10,000 population

All conditions1 ......................................................... 12,642 12,406 1,075.3 1,008.0

Heart disease ........................... 391–392.0,393–398,402,404,410–416,420–429 1,955 2,083 166.3 169.3

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 451 458 38.4 37.2

Coronary atherosclerosis ............................................. 414.0 278 285 23.6 23.2

Other ischemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411–413,414.1–414.9 491 505 41.7 41.0

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 228 256 19.4 20.8

Congestive heart failure .............................................. 428.0 277 373 23.6 30.3

Malignant neoplasms .......................................... 140–208,230–234 772 765 65.7 62.2

Pneumonia ..................................................... 480–486 472 535 40.2 43.5

Fractures ...................................................... 800–829 506 465 43.0 37.8

Psychosis ...................................................... 290–299 341 408 29.0 33.2

Cerebrovascular disease ............................................ 430–438 336 375 28.5 30.5

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 247 222 21.0 18.0

Hyperplasia of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600 247 221 21.0 18.0

Arthropathies and related disorders ...................................... 710–719 191 212 16.3 17.2

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 209 207 17.7 16.8

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 210 201 17.8 16.3

Acute respiratory infection ............................................ 460–466 224 187 19.1 15.2

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 232 98 19.7 7.9

1Includes data for diagnostic conditions not shown in table.

NOTE: This table includes diagnostic categories that accounted for 200,000 or more male discharges in 1988 or 1992.

Table G. Number and rate of female discharges from short-stay hospitals by selected first-listed diagnoses: United States, 1988 and

1992

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic categories and code numbers are based on the International Classification

of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Diagnosis and ICD–9–CM codes 1988 1992 1988 1992

Number in

thousands

Rate per

10,000 population

All conditions1 ......................................................... 18,504 18,545 1,477.4 1,422.0

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V27 3,781 3,910 301.9 299.8

Heart disease ........................... 391–392.0,393–398,402,404,410–416,420–429 1,686 1,852 134.6 142.0

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 265 289 21.2 22.1

Coronary atherosclerosis and other ischemic heart disease . . . . . . . . . . . . . . . . . . . . . . . 411–414 565 597 45.1 45.8

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 263 286 21.0 21.9

Congestive heart failure .............................................. 428.0 357 449 28.5 34.4

Malignant neoplasms .......................................... 140–208,230–234 898 812 71.7 62.3

Fractures ...................................................... 800–829 508 552 40.6 42.3

Fracture of neck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820 186 205 14.9 15.7

Pneumonia ..................................................... 480–486 452 524 36.1 40.1

Psychosis ...................................................... 290–299 440 500 35.1 38.3

Cerebrovascular disease ............................................ 430–438 448 454 35.8 34.8

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 352 358 28.1 27.5

Benign neoplasms and neoplasms of uncertain behavior and unspecified nature ..... 210–229,235–239 350 342 27.9 26.3

Arthropathies and related disorders ...................................... 710–719 267 342 21.3 26.3

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 245 269 19.6 20.6

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 270 263 21.5 20.1

Noninfectious enteritis and colitis ....................................... 555–558 230 220 18.4 16.8

Acute respiratory infection ............................................ 460–466 221 189 17.7 14.5

Abortions and ectopic and molar pregnancies ................................ 630–639 266 179 21.2 13.7

1Includes data for diagnostic conditions not shown in table.

NOTE: This table includes diagnostic categories that accounted for 200,000 or more female discharges in 1988 or 1992.

11
17–18 percent of hospital deaths in 1988 and 1992. Their

average length of stay was 9.4 days in 1988 and 8.5 days

in 1992.

+ Pneumonia, fractures, psychoses, and cerebrovascular disease each accounted for more than 700,000 discharges in

1988 and 1992. Discharges with each of these four

diagnoses used more than 7 million days of care in 1988

and 1992.

+ Females hospitalized for deliveries made up 20 percent of

female discharges in 1988 and 21 percent in 1992.

+ For males, heart disease was the first-listed diagnosis for

15 percent (2.0 million) of discharges in 1988 and 17 percent (2.1 million) in 1992. For females, 9 percent (1.7

million) of hospitalizations in 1988 and 10 percent (1.9

million) in 1992 were for heart disease.

+ For males, malignant neoplasms made up 6 percent of

first-listed diagnoses—772,000 in 1988 and 765,000 in

1992. Females had 898,000 discharges (5 percent) with a

first-listed diagnosis of malignant neoplasms in 1988 and

812,000 (4 percent) in 1992.

+ Only males had more than 200,000 discharges for intervertebral disc disorders in 1988 and 1992. Discharges for

hyperplasia of prostate also exceeded 200,000 in both

years.

+ Only females had more than 200,000 discharges for

cholelithiasis, benign neoplasms and neoplasms of uncertain behavior and unspecified nature, and noninfectious

enteritis and colitis in 1988 and 1992.

12
Utilization of procedures by

sex

Neither the number of discharges with procedures nor the

number with surgical procedures changed significantly from

1988 to 1992 (table 17), using weighted linear regression

analysis. However, the estimates are not comparable across all

years because of coding changes and a revision in the classification of procedures as surgical or nonsurgical. These modifications are discussed in appendix II. The coding changes also

affected the total number of all-listed procedures shown in

tables 18–23.

+ In 1988, 19.9 million discharges (64 percent) had a procedure during hospitalization. In 1992, procedures were

performed on 20.4 million, or 66 percent of discharges.

+ Discharges with surgical procedures made up 49 and

47 percent of all discharges in 1988 and 1992, respectively.

+ At least two-thirds of all procedures performed in shortstay hospitals in 1988 and 1992 were in four procedure

categories: miscellaneous diagnostic and therapeutic procedures (10.9–13.9 million), obstetrical procedures (6.0–

6.7 million), operations on the digestive system (5.3–5.4

million), and operations on the cardiovascular system

(3.6–4.4 million).

+ In 1988 and 1992, procedures performed a million or more

times on hospital inpatients included episiotomy, arteriography and angiocardiography using contrast material, computerized axial tomography (CAT scan), diagnostic

ultrasound, and fetal EKG and other fetal monitoring. In

1992, respiratory therapy and cardiac catheterization were

also done more than a million times.

+ Males had 15.7 million procedures in 1988, compared

with 23.5 million for females. Likewise, in 1992, males

had 16.8 million procedures, but females underwent 25.8

million procedures.

+ Frequent procedures for males in 1988 and 1992 were

arteriography and angiocardiography using contrast material, cardiac catheterization, computerized axial tomography, and diagnostic ultrasound.

+ Procedures commonly performed on females in 1988 and

1992 were episiotomy, fetal EKG and other fetal monitoring, cesarean section, and diagnostic ultrasound.

13
Utilization of selected

sex-specific procedures

Female-specific procedures

Trend data for selected procedures that are only performed on females are shown in tables 24–26. The data for

obstetrical procedures in tables 25 and 26 are for females with

deliveries. Rates are per 100 deliveries, or per 100 vaginal

deliveries when the procedure would not be done during a

cesarean section delivery. The rates for most female-specific

procedures did not change significantly from 1988 to 1992,

using weighted linear regression analysis. For example, there

were no significant changes in the rates for hysterectomy,

episiotomy, or cesarean section.

+ Women had 578,000 hysterectomies in 1988 and 580,000

in 1992. In both years, approximately two-thirds of hysterectomies were performed on women 30–49 years of

age, a fourth on those aged 50 years and over, and

8–9 percent on women 15–29 years of age. Figure 8

illustrates trends in hysterectomy rates for these age

groups.

+ In 1988, 1.7 million episiotomies were performed, for a

rate of 59.0 per 100 vaginal deliveries. In 1992, there were

1.6 million episiotomies, for a rate of 53.8 per 100 vaginal

deliveries.

+ In 1988, cesarean sections were performed 24.7 times per

100 deliveries. In 1992, there were 23.6 cesarean sections

per 100 deliveries. Figure 9 shows the trends in cesarean

section rates by age.

Male-specific procedures

Two frequent procedures performed only on males are

prostatectomy and circumcision of the penis. Trends for

prostatectomy are shown by age in table 27, and table 28

shows circumcision trends by region. The circumcision data

only reflect circumcisions performed in short-stay hospitals on

newborn infants and thus underestimate the total number of

circumcisions performed. From 1988 to 1992, there were no

significant changes in the rates of prostatectomy or male

circumcision, using weighted linear regression analysis.

+ Men had 358,000 prostatectomies in 1988 and 353,000 in

1992. Men 65–74 years of age accounted for 41 percent of

prostatectomies in 1988 and 42 percent in 1992. Those

aged 75 years and over had 40 percent of prostatectomies

in 1988 and 37 percent in 1992. Figure 10 shows the

trends in prostatectomy rates for these two age groups.

+ The proportion of male newborn infants who were circumcised was 58 percent in 1988 and 61 percent in 1992. The

percent circumcised ranged from 45 percent in the West to

73 percent in the Midwest in 1988, and from 38 percent in

the West to 78 percent in the Midwest in 1992 (figure 11).

1988 1989 1990 1991 1992

0

100

200

300

400

500

600

700

800

900

1,000

1,100

1,200

Rate per 100,000 female population

30 49 years

50 years and over

15 29 years

Figure 8. Rate of hysterectomies for females by age: United

States, 1988–92

1988 1989 1990 1991 1992

0

20

25

30

35

Rate per 100 deliveries

Under 20 years

20 24 years

25 29 years

30 34 years

35 years and over

15

Figure 9. Rate of cesarean sections for females by age: United

States, 1988–92

14
1988 1989 1990 1991 1992

1,500

2,000

2,500

3,000

3,500

4,000

Rate per 100,000 male population

75 years and over

65 74 years

0

Figure 10. Rate of prostatectomies for males aged 65–74 years

and 75 years and over: United States, 1988–92

1988 1989 1990 1991 1992

0

40

45

50

55

60

65

70

75

80

85

90

Percent of male newborns

Midwest

Northeast

South

West

35

Figure 11. Percent of male newborn infants circumcised by

region: United States, 1988–92

15
Utilization of selected

heart-related procedures by

sex

Open-heart surgery, removal of coronary artery obstruction, coronary artery bypass graft, and cardiac catheterizations

together accounted for 1.6 million procedures in 1988 and 2.0

million in 1992. Among these four procedures, only one

significant change in rates during the 1988–92 period was

found using weighted linear regression analysis. This was a

68 percent increase in the rate of removal of coronary artery

obstruction. Tables 29–32 show trend data for the four procedures by age and sex. It should be noted that the data for

open-heart surgery, shown in table 29, do not include coronary

artery bypass graft. Estimates for discharges with at least one

coronary artery bypass graft are shown in table 31. The

number of all-listed bypass procedures are shown in tables 18,

20, and 22.

+ Two-thirds (67 percent) of the four heart-related procedures listed above were performed on males in 1988, and

males had 65 percent of these procedures in 1992.

+ In 1988, a total of 92,000 open-heart procedures were

performed—53,000 on males and 39,000 on females. In

1992, there were 104,000 open-heart surgeries—57,000 on

males and 48,000 on females. Figure 12 shows trends in

rates of open-heart surgery by sex.

+ The rate per 100,000 population for removal of coronary

artery obstruction increased from 93.3 in 1988 to 157.2 in

1992. The rate for males increased 57 percent (from 136.1

to 213.3 per 100,000 population) and the rate for females

increased 96 percent (from 53.1 to 104.3 per 100,000

population) from 1988 to 1992 (figure 13).

+ There were 253,000 discharges with coronary artery bypass

grafts in 1988 and 309,000 in 1992. Males made up

75 percent of discharges with bypass surgery (189,000) in

1988 and 72 percent (221,000) in 1992. Female discharges

with bypass surgery numbered 63,000 in 1988 and 88,000

in 1992. Rates of discharges with bypass surgery are

shown by sex in figure 14.

1988 1989 1990 1991 1992

0

30

35

40

45

50

Rate per 100,000 population

Male

Female

Figure 12. Rate of open-heart surgery by sex: United States,

1988–92

1988 1989 1990 1991 1992

50

75

100

125

150

175

200

225

250

Rate per 100,000 population

Male

Female

0

25

Figure 13. Rate of removal of coronary artery obstructions by

sex: United States, 1982–92

1988 1989 1990 1991 1992

0

25

50

75

100

125

150

175

200

Rate per 100,000 population

Male

Female

Figure 14. Rate of discharges with one or more coronary artery

bypass grafts by sex: United States, 1988–92

16
+ An estimated 930,000 cardiac catheterizations were performed in 1988 and 1,028,000 were performed in 1992.

Males underwent 598,000 catheterizations and females

had 332,000 catheterizations in 1988. In 1992, the estimates were 636,000 cardiac catheterizations for males and

392,000 catheterizations for females. Figure 15 displays

trends in rates of cardiac catheterizations by sex.

1988 1989 1990 1991 1992

200

250

300

350

400

450

500

550

600

Rate per 100,000 population

Male

Female

0

Figure 15. Rate of cardiac catheterizations by sex: United States,

1988–92

17
Summary

After a large increase in the 1970’s and an abrupt

decrease in the 1980’s, the discharge rates for short-stay

hospitals leveled off in the 1988–92 period. However, the rate

of days of care continued to decline, falling 10 percent from

1988 to 1992. Average length of stay also declined 5 percent

from 1988 to 1992. Discharge rates did not change significantly in any of the four geographic regions of the country.

The major reasons for hospitalization in both 1988 and

1992 were delivery, heart disease, and malignant neoplasm.

Throughout this period, the majority of procedures performed

were in one of four categories—miscellaneous diagnostic and

therapeutic procedures, obstetrical procedures, operations on

the digestive system, and operations on the cardiovascular

system.

Particular attention was given to commonly performed

sex-specific procedures. Obstetrical procedures, such as

episiotomy, fetal EKG and other fetal monitoring, and cesarean section, were among the leading procedures performed on

females. Other female-specific procedures, such as hysterectomy, were also commonly done. Frequent male-specific procedures were prostatectomy and circumcision. No significant

changes in rates occurred in the 1988–92 period for any of

these sex-specific procedures.

The four heart-related procedures—open-heart surgery,

removal of coronary artery obstruction, coronary artery bypass

graft, and cardiac catheterization—were also examined by sex.

Males accounted for 67 percent of these procedures in 1988

and 64 percent in 1992. The rate for one procedure, removal of

coronary artery obstruction, increased significantly for both

males and females during the 1988–92 period.

18
References

1. Pokras R, Kozak LJ, McCarthy E, Graves EJ. Trends in hospital

utilization: United States, 1965–86. National Center for Health

Statistics. Vital Health Stat 13(101). 1989.

2. Howard G, Cravern TE, Sanders L, Evans GW. Relationship of

hospitalized stroke rate and in-hospital mortality to the decline

in U.S. stroke mortality. Neuroepidemiology 10(5–6):251–9.

1991.

3. Taffel SM, Placek PJ, Moien M, Kosary CL. 1989 U.S. cesarean

section rate steadies - VBAC rate rises to nearly one in five.

Birth 18(2):73–77. 1991.

4. Gillum, RF. Peripheral arterial occlusive disease of the extremities in the United States: hospitalization and mortality. Am

Heart J 120(6 Pt 1):1414–18. 1990.

5. Feinleib M, Havlik RJ, Gillum RF, et al. Coronary heart disease

and related procedures: National Hospital Discharge Survey

data. Circulation 79(6 Suppl I):13–18. 1989.

6. Rosenblum LS, Castro KG, Dooley S, Morgan M. Effect of HIV

infection and tuberculosis on hospitalizations and cost of care

for young adults in the United States, 1985 to 1990. Ann Intern

Med 121(10): 786–92. 1994.

7. Wilcox LS, Koonin LM, Pokras R, et al. Hysterectomy in the

United States, 1988–1990. Obstet-Gynecol 83(4):549–55. 1994.

8. Geiss LS, Herman WH, Goldschmid MG, et al. Surveillance for

diabetes mellitus - United States, 1980–89. MMWR CDC

Surveill Summ 42(2):1–20. 1993.

9. Zahniser SC, Kendrick JS, Franks AL, Saftlas AF. Trends in

obstetric operative procedures, 1980 to 1987. Am J Public

Health 82(10):1340–44. 1992.

10. Kozak LJ. Surgical and nonsurgical procedures associated with

hospital delivery in the United States: 1980–87. Birth 16(4):209–

13. 1989.

11. National Center for Health Statistics. Healthy People 2000

Review, 1993. Hyattsville, Md: Public Health Service. 1994.

12. Simmons WR, Schnack GA. Development of the design of the

NCHS Hospital Discharge Survey. National Center for Health

Statistics. Vital Health Stat 2(39). 1977.

13. Haupt BJ, Kozak LJ. Estimates from two survey designs:

National Hospital Discharge Survey. National Center for Health

Statistics. Vital Health Stat 13(111). 1992.

14. SMG Marketing Group, Inc. Hospital Market Database. Chicago, Illinois: Healthcare Information Specialists. April 1987.

15. SMG Marketing Group, Inc. Hospital Market Database. Chicago, Illinois: Healthcare Information Specialists. April 1991.

16. Public Health Service and Health Care Financing Administration. International Classification of Diseases, 9th Revision,

Clinical Modification, 4th ed. Washington: Public Health Service. 1991.

17. Dawson-Saunders B, Trapp RG. Basic and clinical biostatistics.

Norwalk, Connecticut: Appleton and Lange. 1990.

18. Curtin LR and Klein RJ. Direct standardization (age-adjusted

death rates). National Center for Health Statistics. Healthy

People 2000 Statistical Notes, No 6, March 1995.

19. Shah, BV, Barnwell BG, Hunt PN, LaVange LM. SUDAAN

user’s manual, release 5.50. Research Triangle Park, North

Carolina: Research Triangle Institute. 1991.

20. American Hospital Association. Ambulatory Care Trendlines:

Outpatient Surgery Trends, 1980–90. 1(2). 1992.

21. Rogers CM, ed. Socio-economic factbook for surgery, 1995.

Chicago, Illinois: American College of Surgeons. 1995.

22. Rovner J. USA divides over early discharge of mothers. The

Lancet 346(8968):171–72. 1995.

23. Britton JR, Britton HL, Beebe SA. Early discharge of the term

newborn: a continued dilemma. Pediatrics 94(3):291–95. 1994.

24. Centers for Disease Control. Trends in length of stay for

hospital deliveries-United States, 1970–92. MMWR 44(17):335–

37. 1995.

25. Massey JT, Moore TF, Parsons VL, Tadros W. Design and

estimation for the National Health Interview Survey, 1985–94.

National Center for Health Statistics. Vital Health Stat 2(110).

1989.

26. National Archives and Records Administration. Federal Register 50(147). Washington: National Archives and Records Administration. 31038–40. 1985.

27. Graves EJ. Detailed diagnoses and procedures, National Hospital Discharge Survey, 1992. National Center for Health Statistics. Vital Health Stat 13(118). 1994.

28. Graves EJ. Utilization of short-stay hospitals, United States,

1985, annual summary. National Center for Health Statistics.

Vital Health Stat 13(91). 1987.

29. Graves EJ. National Hospital Discharge Survey: annual summary, 1988. National Center for Health Statistics. Vital Health

Stat 13(106). 1991.

30. Graves EJ, Kozak LJ. National Hospital Discharge Survey:

annual summary, 1989. National Center for Health Statistics.

Vital Health Stat 13(109). 1992.

31. Graves EJ. National Hospital Discharge Survey: annual summary, 1990. National Center for Health Statistics. Vital Health

Stat 13(112). 1992.

32. Haupt BJ. Utilization of short-stay hospitals: annual summary

for the United States, 1980. National Center for Health Statistics. Vital Health Stat 13(64). 1982.

33. Pokras R, Kozak LJ. Adjustment of hospital utilization rates,

United States, 1965–80. National Center for Health Statistics.

Vital Health Stat 13(81). 1984.

34. Graves EJ. National Hospital Discharge Survey: annual summary, 1991. National Center for Health Statistics. Vital Health

Stat 13(114). 1993.

19
35. Graves EJ. National Hospital Discharge Survey: annual summary, 1992. National Center for Health Statistics. Vital Health

Stat 13(119). 1994.

36. Sirken MG. Utilization of short-stay hospitals, summary of

nonmedical statistics, United States, 1965. National Center for

Health Statistics. Vital Health Stat 13(2). 1967.

37. Witkin MJ. Utilization of short-stay hospitals by characteristics

of discharged patients, United States, 1965. National Center for

Health Statistics. Vital Health Stat 13(3). 1967.

38. SMG Marketing Group, Inc. Hospital Market Database. Chicago, Illinois: Healthcare Information Specialists. April 1989.

39. SMG Marketing Group, Inc. Hospital Market Database. Chicago, Illinois: Healthcare Information Specialists. April 1990.

40. SMG Marketing Group, Inc. Hospital Market Database. Chicago, Illinois: Healthcare Information Specialists. April 1992.

41. SMG Marketing Group, Inc. Hospital Market Database. Chicago, Illinois: Healthcare Information Specialists. April 1993.

42. Shah BV. SESUDAAN: Standard errors program for computing

of standardized rates from sample survey data. Research Triangle Park, North Carolina: Research Triangle Institute. 1981.

43. Hansen MH, Hurwitz WN, Madow WG. Sample survey methods and theory, vol 1. New York: John Wiley & Sons. 1953.

44. Cochran WG. Sampling techniques, 3rd ed. New York: John

Wiley & Sons. 1977.

45. Gardocki GJ, Pokras R. Utilization of short-stay hospitals by

persons with heart disease and malignant neoplasms: National

Hospital Discharge Survey, United States, 1977. National Center for Health Statistics. Vital Health Stat 13(52). 1981.

46. Sirken MG, Shimizu BI, French DK, Brock, DB. Manual on

standards and procedures for reviewing statistical reports. Rockville, Maryland: National Center for Health Statistics. 1974.

47. National Committee on Vital and Health Statistics, Technical

Consultant Panel. UHDDS classes of procedures, ICD–9–CM.

Ann Arbor, Michigan: Commission on Professional and Hospital Activities. 1978.

20
List of detailed tables

1. Number and rate of discharges from short-stay hospitals

by sex and age, and age-adjusted rate by sex: United

States, 1980, 1985, and 1988–92 . . . . . . . . . . . . . . . . . . 22

2. Number and rate of days of care for discharges from

short-stay hospitals by sex and age, and age-adjusted rate

by sex: United States, 1980, 1985, and 1988–92 . . . . . . . 23

3. Average length of stay for discharges from short-stay

hospitals by sex and age, and age-adjusted average stay by

sex: United States, 1980, 1985, and 1988–92 . . . . . . . . . 24

4. Number and rate of discharges from short-stay hospitals

by region and age, and age-adjusted rate by region: United

States, 1980, 1985, and 1988–92 . . . . . . . . . . . . . . . . . . 25

5. Number and rate of days of care for discharges from

short-stay hospitals by region and age, and age-adjusted

rate by region: United States, 1980, 1985, and

1988–92 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

6. Average length of stay for discharges from short-stay

hospitals by region and age, and age-adjusted average stay

by region: United States, 1980, 1985, and 1988–92 . . . . . 27

7. Number of deaths and fatality rate for discharges from

short-stay hospitals by selected categories of first-listed

diagnosis: United States, 1980, 1985, and 1988–92 . . . . . 28

8. Number of discharges from short-stay hospitals by firstlisted diagnosis: United States, 1980, 1985, and

1988–92 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

9. Rate of discharges from short-stay hospitals by first-listed

diagnosis: United States, 1980, 1985, and 1988–92 . . . . . 30

10. Number of days of care for discharges from short-stay

hospitals by first-listed diagnosis: United States, 1980,

1985, and 1988–92 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

11. Rate of days of care for discharges from short-stay hospitals by first-listed diagnosis: United States, 1980, 1985,

and 1988–92 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

12. Average length of stay for discharges from short-stay

hospitals by first-listed diagnosis: United States, 1980,

1985, and 1988–92 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

13. Number of male discharges from short-stay hospitals by

first-listed diagnosis: United States, 1980, 1985, and 1988–

92. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

14. Rate of male discharges from short-stay hospitals by

first-listed diagnosis: United States, 1980, 1985, and 1988–

92. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

15. Number of female discharges from short-stay hospitals by

first-listed diagnosis: United States, 1980, 1985, and 1988–

92. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

16. Rate of female discharges from short-stay hospitals by

first-listed diagnosis: United States, 1980, 1985, and 1988–

92. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

17. Number of discharges from short-stay hospitals with and

without procedures and percent with procedures: United

States, 1980, 1985, and 1988–92 . . . . . . . . . . . . . . . . . . 38

18. Number of all-listed procedures for discharges from shortstay hospitals by procedure category: United States, 1980,

1985, and 1988–92 ............................ 39

19. Rate of all-listed procedures for discharges from short-stay

hospitals by procedure category: United States, 1980,

1985, and 1988–92 ............................ 40

20. Number of all-listed procedures for male discharges from

short-stay hospitals by procedure category: United States,

1980, 1985, and 1988–92........................ 41

21. Rate of all-listed procedures for male discharges from

short-stay hospitals by procedure category: United States,

1980, 1985, and 1988–92........................ 42

22. Number of all-listed procedures for female discharges

from short-stay hospitals by procedure category: United

States, 1980, 1985, and 1988–92 .................. 43

23. Rate of all-listed procedures for female discharges from

short-stay hospitals by procedure category: United States,

1980, 1985, and 1988–92........................ 44

24. Number and rate of hysterectomies for female discharges

from short-stay hospitals by age: United States, 1980,

1985, and 1988–92 ............................ 45

25. Number and rate of selected obstetrical procedures for

females with deliveries discharged from short-stay hospitals by type of procedure: United States, 1980, 1985, and

1988–92 .................................... 46

26. Number and rate of cesarean sections for females with

deliveries discharged from short-stay hospitals by age:

United States, 1980, 1985, and 1988–92 ............. 47

27. Number and rate of prostatectomies for male discharges

from short-stay hospitals by age: United States, 1980,

1985, and 1988–92 ............................ 48

28. Number of male newborn infants and number and percent

circumcised in short-stay hospitals by region: United

States, 1980, 1985, and 1988–92 .................. 49

29. Number and rate of open-heart surgeries for discharges

from short-stay hospitals, by sex and age: United States,

1980, 1985, and 1988–92........................ 50

30. Number and rate of removal of coronary artery obstructions for discharges from short-stay hospitals by sex and

age: United States, 1980, 1985, and 1988–92 ......... 51

31. Number and rate of discharges from short-stay hospitals

with one or more coronary artery bypass grafts by sex and

age: United States, 1980, 1985, and 1988–92 ......... 52

32. Number and rate of cardiac catheterizations for discharges

from short-stay hospitals by sex and age: United States,

1980, 1985, and 1988–92........................ 53

21
Table 1. Number and rate of discharges from short-stay hospitals by sex and age, and age-adjusted rate by sex: United States, 1980,

1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants]

Sex and year All ages

Under

15 years

15–44

years

45–64

years

65 years

and over

Ageadjusted rate1

Both sexes Number of discharges in thousands

1980 ................................ 37,832 3,672 15,635 8,660 9,864 . . .

1985 ................................ 35,056 2,972 13,966 7,610 10,508 . . .

1988 ................................ 31,146 2,610 11,934 6,456 10,146 . . .

1989 ................................ 30,947 2,597 11,848 6,271 10,230 . . .

1990 ................................ 30,788 2,412 11,799 6,244 10,333 . . .

1991 ................................ 31,098 2,498 11,620 6,173 10,806 . . .

1992 ................................ 30,951 2,531 11,227 6,329 10,864 . . .

Male

1980 ................................ 15,145 2,063 4,687 4,127 4,268 . . .

1985 ................................ 14,160 1,698 4,153 3,776 4,533 . . .

1988 ................................ 12,642 1,486 3,485 3,221 4,450 . . .

1989 ................................ 12,583 1,521 3,405 3,179 4,478 . . .

1990 ................................ 12,280 1,362 3,330 3,115 4,472 . . .

1991 ................................ 12,478 1,435 3,248 3,088 4,708 . . .

1992 ................................ 12,406 1,416 3,162 3,135 4,692 . . .

Female

1980 ................................ 22,686 1,609 10,949 4,533 5,596 . . .

1985 ................................ 20,896 1,274 9,813 3,834 5,975 . . .

1988 ................................ 18,504 1,125 8,448 3,235 5,696 . . .

1989 ................................ 18,364 1,077 8,443 3,092 5,752 . . .

1990 ................................ 18,508 1,049 8,469 3,129 5,861 . . .

1991 ................................ 18,620 1,064 8,372 3,085 6,098 . . .

1992 ................................ 18,545 1,115 8,064 3,194 6,172 . . .

Both sexes Rate of discharges per 1,000 population

1980 ................................ 167.7 71.6 150.1 194.8 383.7 167.7

1985 ................................ 148.4 57.7 125.0 170.8 369.8 146.6

1988 ................................ 128.3 49.8 103.9 142.1 336.8 125.7

1989 ................................ 126.2 48.8 102.7 136.8 333.4 123.5

1990 ................................ 124.3 44.6 101.6 135.0 330.9 121.3

1991 ................................ 124.1 45.3 99.3 132.2 340.3 121.0

1992 ................................ 122.1 45.2 96.0 131.0 336.5 118.8

Male

1980 ................................ 139.0 78.7 91.5 195.3 411.8 145.6

1985 ................................ 124.0 64.4 75.3 177.6 397.9 129.7

1988 ................................ 107.5 55.3 61.3 148.0 367.8 112.0

1989 ................................ 106.0 55.8 59.5 144.6 363.1 110.0

1990 ................................ 102.2 49.2 57.8 140.2 356.1 106.1

1991 ................................ 102.7 50.8 55.9 137.5 368.1 106.4

1992 ................................ 100.8 49.4 54.4 134.7 359.7 103.9

Female

1980 ................................ 194.4 64.2 206.8 194.3 364.7 189.9

1985 ................................ 171.2 50.6 173.5 164.6 351.0 164.0

1988 ................................ 147.7 43.9 145.8 136.7 316.0 140.2

1989 ................................ 145.3 41.5 145.1 129.7 313.5 137.7

1990 ................................ 145.0 39.7 144.7 130.2 314.0 137.3

1991 ................................ 144.3 39.5 142.1 127.2 321.6 136.3

1992 ................................ 142.2 40.8 137.1 127.6 320.8 134.3

. . . Category not applicable.

1See appendix II for method of computation.

22
Table 2. Number and rate of days of care for discharges from short-stay hospitals by sex and age, and age-adjusted rate by sex:

United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants]

Sex and year All ages

Under 15

years

15–44

years

45–64

years

65 years

and over

Ageadjusted

rate1

Both sexes Number of days of care in thousands

1980 ................................ 274,508 16,191 81,951 71,008 105,358 . . .

1985 ................................ 226,217 13,554 67,397 53,541 91,726 . . .

1988 ................................ 203,678 13,028 56,558 43,901 90,191 . . .

1989 ................................ 200,827 12,632 55,420 41,979 90,795 . . .

1990 ................................ 197,422 11,655 54,062 42,153 89,552 . . .

1991 ................................ 199,099 12,037 54,020 40,100 92,942 . . .

1992 ................................ 190,386 12,289 48,660 39,952 89,484 . . .

Male

1980 ................................ 116,267 8,950 29,748 33,589 43,981 . . .

1985 ................................ 97,269 7,647 25,268 26,135 38,219 . . .

1988 ................................ 89,435 7,493 21,996 21,855 38,091 . . .

1989 ................................ 88,493 7,408 21,155 21,429 38,501 . . .

1990 ................................ 85,067 6,484 20,388 20,961 37,234 . . .

1991 ................................ 86,930 6,981 20,698 20,157 39,095 . . .

1992 ................................ 83,664 6,946 19,108 20,082 37,527 . . .

Female

1980 ................................ 158,241 7,241 52,204 37,420 61,377 . . .

1985 ................................ 128,948 5,907 42,128 27,405 53,507 . . .

1988 ................................ 114,242 5,536 34,562 22,045 52,100 . . .

1989 ................................ 112,334 5,225 34,265 20,551 52,294 . . .

1990 ................................ 112,355 5,171 33,674 21,191 52,318 . . .

1991 ................................ 112,168 5,056 33,322 19,944 53,846 . . .

1992 ................................ 106,722 5,342 29,552 19,870 51,957 . . .

Both sexes Rate of days of care per 1,000 population

1980 ................................ 1,216.7 315.7 786.8 1,596.9 4,098.4 1,216.7

1985 ................................ 957.7 263.0 603.3 1,201.6 3,228.0 942.9

1988 ................................ 838.8 248.4 492.6 966.5 2,994.1 815.5

1989 ................................ 819.3 237.4 480.3 915.9 2,959.2 793.4

1990 ................................ 796.9 215.4 465.3 911.5 2,867.7 770.2

1991 ................................ 794.6 218.3 461.8 858.5 2,927.0 765.5

1992 ................................ 751.0 219.6 416.1 827.1 2,771.7 720.8

Male

1980 ................................ 1,067.4 341.3 580.9 1,589.5 4,243.6 1,142.5

1985 ................................ 851.9 289.9 458.2 1,229.0 3,354.9 901.9

1988 ................................ 760.7 279.0 386.8 1,004.5 3,148.5 798.7

1989 ................................ 745.1 271.9 369.9 974.6 3,121.8 780.3

1990 ................................ 708.2 234.1 353.6 943.6 2,964.7 740.2

1991 ................................ 715.2 247.3 356.5 897.4 3,056.5 745.9

1992 ................................ 679.7 242.4 328.8 862.9 2,876.7 704.7

Female

1980 ................................ 1,356.0 288.8 985.9 1,603.7 4,000.3 1,292.7

1985 ................................ 1,056.6 234.8 744.8 1,176.5 3,143.0 987.2

1988 ................................ 912.1 216.2 596.4 931.5 2,890.3 837.4

1989 ................................ 888.9 201.1 588.8 861.7 2,849.9 812.1

1990 ................................ 880.3 195.8 575.4 881.9 2,802.6 803.3

1991 ................................ 869.3 187.9 565.6 822.4 2,839.6 789.4

1992 ................................ 818.3 195.6 502.3 793.8 2,700.5 740.5

. . . Category not applicable.

1See appendix II for method of computation.

23
Table 3. Average length of stay for discharges from short-stay hospitals by sex and age, and age-adjusted average stay by sex: United

States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants]

Sex and year All ages

Under

15 years

15–44

years

45–64

years

65 years

and over

Age

adjusted1

Both sexes Average length of stay in days

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 4.4 5.2 8.2 10.7 7.3

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 4.6 4.8 7.0 8.7 6.4

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 5.0 4.7 6.8 8.9 6.5

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 4.9 4.7 6.7 8.9 6.4

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 4.8 4.6 6.8 8.7 6.3

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 4.8 4.6 6.5 8.6 6.3

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2 4.9 4.3 6.3 8.2 6.1

Male

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7 4.3 6.3 8.1 10.3 7.8

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9 4.5 6.1 6.9 8.4 7.0

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 5.0 6.3 6.8 8.6 7.1

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.0 4.9 6.2 6.7 8.6 7.1

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9 4.8 6.1 6.7 8.3 7.0

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.0 4.9 6.4 6.5 8.3 7.0

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 4.9 6.0 6.4 8.0 6.8

Female

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.0 4.5 4.8 8.3 11.0 6.8

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2 4.6 4.3 7.1 9.0 6.0

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2 4.9 4.1 6.8 9.1 6.0

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 4.9 4.1 6.6 9.1 5.9

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 4.9 4.0 6.8 8.9 5.9

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.0 4.8 4.0 6.5 8.8 5.8

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8 4.8 3.7 6.2 8.4 5.5

1See appendix II for method of computation.

24
Table 4. Number and rate of discharges from short-stay hospitals by region and age, and age-adjusted rate by region: United States,

1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants]

Region and year All ages

Under

15 years

15–44

years

45–64

years

65 years

and over

All

ages

Under

15 years

15–44

years

45–64

years

65 years

and over

Ageadjusted

rate1

Number in thousands Rate per 1,000 populatuion

United States

1980 ................................ 37,832 3,672 15,635 8,660 9,864 167.7 71.6 150.1 194.8 383.7 167.7

1985 ................................ 35,056 2,972 13,966 7,610 10,508 148.4 57.7 125.0 170.8 369.8 146.6

1988 ................................ 31,146 2,610 11,934 6,456 10,146 128.3 49.8 103.9 142.1 336.8 125.7

1989 ................................ 30,947 2,597 11,848 6,271 10,230 126.2 48.8 102.7 136.8 333.4 123.5

1990 ................................ 30,788 2,412 11,799 6,244 10,333 124.3 44.6 101.6 135.0 330.9 121.3

1991 ................................ 31,098 2,498 11,620 6,173 10,806 124.1 45.3 99.3 132.2 340.3 121.0

1992 ................................ 30,951 2,531 11,227 6,329 10,864 122.1 45.2 96.0 131.0 336.5 118.8

Northeast

1980 ................................ 7,868 700 3,107 1,886 2,176 160.3 67.7 140.3 179.6 356.7 156.2

1985 ................................ 7,168 529 2,673 1,614 2,353 144.1 54.2 114.1 161.1 358.2 137.6

1988 ................................ 7,078 634 2,503 1,514 2,428 140.3 64.4 105.0 151.7 356.0 133.6

1989 ................................ 7,044 621 2,579 1,455 2,389 139.1 62.3 108.3 146.0 346.4 132.4

1990 ................................ 6,895 550 2,566 1,425 2,354 135.9 54.5 108.1 143.5 337.7 129.1

1991 ................................ 7,153 662 2,522 1,455 2,515 140.6 64.5 106.7 146.4 357.0 133.5

1992 ................................ 7,141 570 2,494 1,553 2,524 139.9 55.0 106.8 152.3 354.2 132.2

Midwest

1980 ................................ 10,878 1,105 4,465 2,488 2,820 185.1 81.3 165.5 217.3 419.1 185.4

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,111 754 3,538 1,996 2,823 155.3 57.6 129.5 181.3 389.4 153.0

1988 ................................ 7,832 654 2,868 1,607 2,703 132.5 50.4 104.2 145.1 357.8 129.0

1989 ................................ 7,676 646 2,792 1,553 2,685 129.4 49.3 101.7 139.9 350.7 125.7

1990 ................................ 7,620 575 2,760 1,583 2,703 127.8 43.5 100.3 142.0 348.5 123.9

1991 ................................ 7,315 570 2,602 1,441 2,702 121.7 42.7 94.0 128.6 343.9 117.6

1992 ................................ 7,121 659 2,394 1,386 2,683 117.5 49.1 86.6 119.8 336.9 113.2

South

1980 ................................ 12,983 1,387 5,416 2,883 3,297 173.4 79.3 157.4 199.4 385.8 174.0

1985 ................................ 12,274 1,274 5,006 2,650 3,344 152.4 71.0 132.2 175.0 349.2 151.5

1988 ................................ 10,845 704 4,340 2,293 3,508 130.6 38.6 111.3 147.4 341.8 128.2

1989 ................................ 10,960 796 4,350 2,269 3,545 130.7 43.3 110.9 144.1 337.6 127.9

1990 ................................ 11,173 770 4,342 2,318 3,743 131.6 41.3 109.8 145.2 348.9 128.4

1991 ................................ 11,290 803 4,216 2,293 3,978 131.2 42.3 105.4 141.7 363.5 127.6

1992 ................................ 11,256 819 4,066 2,396 3,975 128.9 42.5 101.4 142.7 356.4 125.2

West

1980 ................................ 6,103 480 2,647 1,403 1,572 142.2 48.6 128.3 174.2 362.5 145.9

1985 ................................ 6,502 415 2,749 1,350 1,988 137.6 38.6 118.9 161.0 396.0 140.5

1988 ................................ 5,391 618 2,224 1,042 1,507 107.4 54.1 90.8 118.3 274.7 108.8

1989 ................................ 5,268 535 2,128 994 1,611 102.6 45.4 85.4 110.2 286.1 104.1

1990 ................................ 5,100 516 2,131 919 1,533 97.1 42.5 84.0 99.8 265.6 98.4

1991 ................................ 5,340 464 2,281 983 1,612 99.7 37.0 88.8 104.8 272.6 101.1

1992 ................................ 5,433 484 2,273 994 1,683 99.5 37.4 87.9 101.8 278.4 100.9

1See appendix II for method of computation.

25
Table 5. Number and rate of days of care for discharges from short-stay hospitals by region and age, and age-adjusted rate by region:

United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants]

Region and year

All

ages

Under

15 years

15–44

years

45–64

years

65 years

and over

All

ages

Under

15 years

15–44

years

45–64

years

65 years

and over

Ageadjusted

rate1

United States Number of days of care in thousands Rate of days of care per 1,000 population

1980 ................................ 274,508 16,191 81,951 71,008 105,358 1,216.7 315.7 786.8 1,596.9 4,098.4 1,216.7

1985 ................................ 226,217 13,554 67,397 53,541 91,726 957.7 263.0 603.3 1,201.6 3,228.0 942.9

1988 ................................ 203,678 13,028 56,558 43,901 90,191 838.8 248.4 492.6 966.5 2,994.1 815.5

1989 ................................ 200,827 12,632 55,420 41,979 90,795 819.3 237.4 480.3 915.9 2,959.2 793.4

1990 ................................ 197,422 11,655 54,062 42,153 89,552 796.9 215.4 465.3 911.5 2,867.7 770.2

1991 ................................ 199,099 12,037 54,020 40,100 92,942 794.6 218.3 461.8 858.5 2,927.0 765.5

1992 ................................ 190,386 12,289 48,660 39,952 89,482 751.0 219.6 416.1 827.1 2,771.7 720.8

Northeast

1980 ................................ 67,238 3,196 17,592 17,784 28,666 1,370.1 309.2 794.7 1,693.7 4,699.3 1,306.4

1985 ................................ 55,513 2,391 13,956 13,240 25,925 1,115.6 245.1 595.9 1,321.8 3,947.1 1,041.1

1988 ................................ 54,554 3,193 13,126 11,809 26,426 1,081.0 324.5 550.9 1,183.3 3,875.4 1,002.8

1989 ................................ 54,182 3,273 13,953 11,116 25,840 1,069.9 328.1 586.2 1,115.6 3,747.6 992.0

1990 ................................ 52,823 2,669 13,931 11,177 25,045 1,041.4 264.3 587.1 1,125.7 3,592.8 962.3

1991 ................................ 52,518 3,334 13,227 10,465 25,491 1,032.4 324.9 559.9 1,052.9 3,619.4 952.2

1992 ................................ 51,288 2,681 12,507 10,984 25,116 1,005.1 258.7 535.8 1,077.1 3,525.1 920.1

Midwest

1980 ................................ 82,000 5,014 25,142 21,286 30,559 1,395.7 369.0 931.7 1,859.0 4,542.0 1,397.9

1985 ................................ 61,514 3,932 18,987 14,376 24,219 1,048.5 300.6 694.9 1,305.7 3,340.0 1,027.0

1988 ................................ 50,118 2,887 13,526 10,706 22,999 847.8 222.5 491.7 966.5 3,044.6 815.0

1989 ................................ 49,046 3,026 13,328 10,180 22,513 826.7 230.7 485.4 916.8 2,940.9 792.3

1990 ................................ 48,698 2,674 12,971 10,613 22,441 816.4 202.2 471.3 952.3 2,893.7 780.9

1991 ................................ 47,448 2,746 12,625 9,298 22,780 789.6 205.7 456.2 829.8 2,899.3 751.3

1992 ................................ 43,903 3,087 10,914 8,519 21,384 724.6 230.0 394.8 736.9 2,685.7 685.8

South

1980 ................................ 88,216 6,072 27,154 22,325 32,665 1,178.0 347.4 789.3 1,544.1 3,822.7 1,183.2

1985 ................................ 73,817 5,479 23,212 17,862 27,265 916.7 305.3 613.2 1,179.1 2,846.9 909.2

1988 ................................ 67,658 3,139 19,690 15,139 29,690 814.9 172.3 505.0 972.9 2,892.7 793.7

1989 ................................ 68,983 3,458 19,851 14,951 30,723 822.9 188.3 506.2 949.2 2,926.0 797.0

1990 ................................ 67,810 3,438 18,642 14,962 30,769 799.0 184.6 471.3 937.3 2,868.1 771.0

1991 ................................ 70,331 3,646 19,054 14,658 32,973 817.2 192.3 476.5 905.7 3,013.4 785.5

1992 ................................ 67,141 3,962 17,227 15,147 30,804 769.1 205.8 429.5 902.3 2,761.5 737.6

West

1980 ................................ 37,054 1,909 12,065 9,613 13,469 863.6 193.1 584.7 1,193.4 3,106.9 903.0

1985 ................................ 35,373 1,751 11,242 8,062 14,318 748.4 162.9 486.4 961.8 2,852.1 776.1

1988 ................................ 31,347 3,810 10,216 6,246 11,075 624.3 333.5 417.1 709.3 2,018.4 638.1

1989 ................................ 28,615 2,875 8,288 5,733 11,719 557.5 244.4 332.6 635.8 2,080.9 571.5

1990 ................................ 28,091 2,874 8,519 5,401 11,297 535.0 236.5 335.8 586.5 1,956.5 547.3

1991 ................................ 28,802 2,311 9,114 5,679 11,698 538.0 184.0 354.8 605.5 1,979.1 550.5

1992 ................................ 28,053 2,559 8,012 5,302 12,180 513.9 198.0 309.9 543.4 2,015.6 524.8

1See appendix II for method of computation.

26
Table 6. Average length of stay for discharges from short-stay hospitals by region and age, and age-adjusted average stay by region:

United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants]

Region and year

All

ages

Under

15 years

15–44

years

45–64

years

65 years

and over

Age

adjusted1

United States Average length of stay in days

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 4.4 5.2 8.2 10.7 7.3

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 4.6 4.8 7.0 8.7 6.4

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 5.0 4.7 6.8 8.9 6.5

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 4.9 4.7 6.7 8.9 6.4

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 4.8 4.6 6.8 8.7 6.3

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 4.8 4.6 6.5 8.6 6.3

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2 4.9 4.3 6.3 8.2 6.1

Northeast

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5 4.6 5.7 9.4 13.2 8.4

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7 4.5 5.2 8.2 11.0 7.6

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7 5.0 5.2 7.8 10.9 7.5

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7 5.3 5.4 7.6 10.8 7.5

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7 4.8 5.4 7.8 10.6 7.5

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 5.0 5.2 7.2 10.1 7.1

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2 4.7 5.0 7.1 10.0 7.0

Midwest

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.5 4.5 5.6 8.6 10.8 7.5

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8 5.2 5.4 7.2 8.6 6.7

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 4.4 4.7 6.7 8.5 6.3

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 4.7 4.8 6.6 8.4 6.3

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 4.6 4.7 6.7 8.3 6.3

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 4.8 4.9 6.5 8.4 6.4

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2 4.7 4.6 6.1 8.0 6.1

South

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8 4.4 5.0 7.7 9.9 6.8

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.0 4.3 4.6 6.7 8.2 6.0

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2 4.5 4.5 6.6 8.5 6.2

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3 4.3 4.6 6.6 8.7 6.2

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 4.5 4.3 6.5 8.2 6.0

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2 4.5 4.5 6.4 8.3 6.2

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.0 4.8 4.2 6.3 7.7 5.9

West

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 4.0 4.6 6.8 8.6 6.2

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4 4.2 4.1 6.0 7.2 5.5

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8 6.2 4.6 6.0 7.3 5.9

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4 5.4 3.9 5.8 7.3 5.5

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.5 5.6 4.0 5.9 7.4 5.6

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4 5.0 4.0 5.8 7.3 5.4

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2 5.3 3.5 5.3 7.2 5.2

1See appendix II for method of computation.

27
Table 7. Number of deaths and fatality rate for discharges from short-stay hospitals by selected categories of first-listed diagnosis:

United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code numbers are based on the International Classification of

Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

First-listed diagnosis and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Number of deaths in thousands

All deaths1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 964 944 947 883 877 918 821

Heart disease ...... 391–392.0,393–398,402,404,410–416,420–429 269 246 222 187 190 207 189

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . 410 80 117 99 84 84 86 81

Congestive heart failure ......................... 428.0 40 45 54 44 53 60 57

Malignant neoplasms .................... 140–208,230–234 242 190 167 161 150 151 140

Pneumonia ................................ 480–486 45 65 77 77 82 82 72

Cerebrovascular disease ....................... 430–438 99 80 77 65 67 69 61

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 038 14 29 36 32 37 40 42

Injury and poisoning .......................... 800–999 39 43 45 47 43 41 39

Fatality rate per 100 discharges

All deaths1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 2.7 3.0 2.9 2.8 3.0 2.7

Heart disease ...... 391–392.0,393–398,402,404,410–416,420–429 8.4 6.9 6.1 5.3 5.3 5.6 4.8

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . 410 18.4 15.5 13.8 12.1 12.5 12.3 10.8

Congestive heart failure ......................... 428.0 9.9 8.1 8.5 6.8 7.5 7.9 6.9

Malignant neoplasms .................... 140–208,230–234 12.9 9.9 10.0 10.0 9.6 9.5 8.9

Pneumonia ................................ 480–486 5.7 7.6 8.3 7.5 7.8 7.6 6.8

Cerebrovascular disease ....................... 430–438 12.4 8.7 9.8 8.2 8.2 8.3 7.3

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 038 23.7 19.5 18.4 16.5 17.2 16.7 15.0

Injury and poisoning .......................... 800–999 1.1 1.3 1.6 1.7 1.6 1.5 1.5

1Incudes deaths for diagnoses not shown in table.

28
Table 8. Number of discharges from short-stay hospitals by first-listed diagnosis: United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code numbers are based on the International Classification of

Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

First-listed diagnosis and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Number of discharges in thousands

All conditions .............................................. 37,832 35,056 31,146 30,947 30,788 31,098 30,951

Infectious and parasitic diseases ............................ 001–139 649 669 693 726 737 759 808

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 038 59 149 193 196 216 240 279

Neoplasms ......................................... 140–239 2,476 2,411 2,098 2,001 1,965 2,001 1,999

Malignant neoplasms ............................ 140–208,230–234 1,873 1,911 1,670 1,608 1,571 1,594 1,577

Malignant neoplasm of large intestine and rectum ........... 153–154,197.5 200 197 165 167 175 168 161

Malignant neoplasm of trachea, bronchus, and lung ......... 162,197.0,197.3 277 315 236 239 231 236 215

Malignant neoplasm of breast ....................... 174–175,198.81 213 208 177 163 164 158 170

Benign neoplasms and neoplasms of uncertain behavior and unspecified

nature ..................................... 210–229,235–239 604 500 428 392 393 407 422

Endocrine, nutritional and metabolic diseases, and immunity disorders .... 240–279 1,145 1,068 1,038 1,097 1,089 1,143 1,178

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 645 480 454 438 420 429 476

Volume depletion ...................................... 276.5 100 239 266 285 319 329 308

Diseases of the blood and blood-forming organs .................. 280–289 336 342 295 318 324 348 322

Mental disorders ...................................... 290–319 1,692 1,700 1,559 1,514 1,538 1,657 1,711

Psychoses ........................................ 290–299 507 701 781 773 812 902 908

Alcohol dependence syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 439 388 237 218 239 228 258

Diseases of the nervous system and sense organs ................ 320–389 1,762 1,211 922 819 770 755 708

Diseases of the central nervous system ................. 320–336,340–349 408 425 348 341 342 331 314

Diseases of the ear and mastoid process ..................... 380–389 405 259 200 177 157 144 145

Diseases of the circulatory system .......................... 390–459 5,140 5,470 5,296 5,197 5,161 5,338 5,597

Heart disease .............. 391–392.0,393–398,402,404,410–416,420–429 3,201 3,584 3,641 3,534 3,556 3,704 3,935

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 431 755 716 695 675 697 747

Coronary atherosclerosis ................................ 414.0 562 304 411 407 410 384 416

Other ischemic heart disease . . . . . . . . . . . . . . . . . . . 411–413,414.1–414.9 793 992 921 893 870 876 971

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 389 511 491 487 483 536 542

Congestive heart failure ................................ 428.0 401 557 634 643 701 764 822

Cerebrovascular disease ............................... 430–438 796 916 784 795 812 835 829

Diseases of the respiratory system .......................... 460–519 3,445 3,238 2,937 2,996 2,966 3,052 2,923

Acute respiratory infections .............................. 460–466 523 464 445 475 487 518 376

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . 474 457 288 197 134 102 76 73

Pneumonia ........................................ 480–486 782 854 924 1,033 1,052 1,088 1,059

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 408 462 479 475 476 490 463

Diseases of the digestive system ........................... 520–579 4,650 3,873 3,268 3,295 3,239 3,256 3,187

Ulcers of the stomach and small intestine ..................... 531–534 363 292 256 256 244 237 232

Appendicitis ....................................... 540–543 266 250 242 227 238 232 227

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 509 384 257 213 168 135 112

Noninfectious enteritis and colitis .......................... 555–558 621 474 362 378 373 351 354

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 458 474 484 482 506 552 512

Diseases of the genitourinary system ......................... 580–629 3,599 2,805 2,204 2,191 2,175 2,071 2,018

Calculus of kidney and ureter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 310 325 287 278 272 241 218

Hyperplasia of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600 276 246 247 249 259 229 221

Complications of pregnancy, childbirth, and the puerperium1 ........... 630–676 1,010 968 837 756 734 723 662

Abortions and ectopic and molar pregnancies .................. 630–639 531 382 266 229 208 180 179

Diseases of the skin and subcutaneous tissue ................... 680–709 597 542 460 480 462 462 462

Cellulitis and abscess ................................. 681–682 201 257 280 303 288 297 307

Diseases of the musculoskeletal system and connective tissue ......... 710–739 2,245 2,170 1,647 1,569 1,592 1,600 1,610

Arthropathies and related disorders ......................... 710–719 543 465 459 431 479 526 554

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 385 508 417 396 425 391 407

Congenital anomalies ................................... 740–759 343 269 227 207 182 192 191

Certain conditions originating in the perinatal period ................ 760–779 91 159 158 152 163 147 141

Symptoms, signs, and ill-defined conditions ..................... 780–799 637 534 398 381 410 386 350

Injury and poisoning ................................... 800–999 3,593 3,303 2,817 2,806 2,774 2,768 2,701

Fractures, all sites ................................... 800–829 1,163 1,129 1,014 1,021 1,017 1,034 1,016

Fracture of neck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820 210 258 254 265 281 300 278

Intracranial injuries (excluding those with skull fracture) ............ 850–854 295 268 201 186 184 180 152

Lacerations and open wounds ............................ 870–904 334 277 232 224 240 193 180

Supplementary classifications .............................. V01–V82 4,421 4,324 4,295 4,444 4,507 4,438 4,383

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V27 3,762 3,854 3,781 3,937 4,025 3,973 3,910

1The first-listed diagnosis for females with deliveries is coded V27, shown under ‘‘Supplementary classifications.’’

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

29
Table 9. Rate of discharges from short-stay hospitals by first-listed diagnosis: United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code numbers are based on the International Classification of

Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

First-listed diagnosis and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Rate of discharges per 10,000 population

All conditions .............................................. 1,676.8 1,484.1 1,282.7 1,262.5 1,242.7 1,241.1 1,221.0

Infectious and parasitic diseases ............................ 001–139 28.8 28.3 28.5 29.6 29.7 30.3 31.9

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 038 2.6 6.3 8.0 8.0 8.7 9.6 11.0

Neoplasms ......................................... 140–239 109.8 102.1 86.4 81.6 79.3 79.9 78.9

Malignant neoplasms ............................ 140–208,230–234 83.0 80.9 68.8 65.6 63.4 63.6 62.2

Malignant neoplasm of large intestine and rectum ........... 153–154,197.5 8.9 8.3 6.8 6.8 7.1 6.7 6.3

Malignant neoplasm of trachea, bronchus, and lung ......... 162,197.0,197.3 12.3 13.3 9.7 9.8 9.3 9.4 8.5

Malignant neoplasm of breast ....................... 174–175,198.81 9.4 8.8 7.3 6.7 6.6 6.3 6.7

Benign neoplasms and neoplasms of uncertain behavior and unspecified

nature ..................................... 210–229,235–239 26.8 21.2 17.6 16.0 15.9 16.2 16.6

Endocrine, nutritional and metabolic diseases, and immunity disorders .... 240–279 50.8 45.2 42.7 44.7 44.0 45.6 46.5

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 28.6 20.3 18.7 17.9 17.0 17.1 18.8

Volume depletion ...................................... 276.5 4.4 10.1 10.9 11.6 12.9 13.1 12.2

Diseases of the blood and blood-forming organs .................. 280–289 14.9 14.5 12.1 13.0 13.1 13.9 12.7

Mental disorders ...................................... 290–319 75.0 72.0 64.2 61.8 62.1 66.1 67.5

Psychoses ........................................ 290–299 22.5 29.7 32.2 31.5 32.8 36.0 35.8

Alcohol dependence syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 19.5 16.4 9.8 8.9 9.6 9.1 10.2

Diseases of the nervous system and sense organs ................ 320–389 78.1 51.3 38.0 33.4 31.1 30.1 27.9

Diseases of the central nervous system ................. 320–336,340–349 18.1 18.0 14.3 13.9 13.8 13.2 12.4

Diseases of the ear and mastoid process ..................... 380–389 18.0 11.0 8.3 7.2 6.4 5.8 5.7

Diseases of the circulatory system .......................... 390–459 227.8 231.6 218.1 212.0 208.3 213.1 220.8

Heart disease .............. 391–392.0,393–398,402,404,410–416,420–429 141.9 151.7 150.0 144.1 143.5 147.8 155.2

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 19.1 31.9 29.5 28.3 27.2 27.8 29.5

Coronary atherosclerosis ................................ 414.0 24.9 12.9 16.9 16.6 16.5 15.3 16.4

Other ischemic heart disease . . . . . . . . . . . . . . . . . . . 411–413,414.1–414.9 35.1 42.0 37.9 36.4 35.1 35.0 38.3

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 17.2 21.6 20.2 19.9 19.5 21.4 21.4

Congestive heart failure ................................ 428.0 17.8 23.6 26.1 26.2 28.3 30.5 32.4

Cerebrovascular disease ............................... 430–438 35.3 38.8 32.3 32.4 32.8 33.3 32.7

Diseases of the respiratory system .......................... 460–519 152.7 137.1 120.9 122.2 119.7 121.8 115.3

Acute respiratory infections .............................. 460–466 23.2 19.7 18.3 19.4 19.7 20.7 14.8

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . 474 20.3 12.2 8.1 5.5 4.1 3.0 2.9

Pneumonia ........................................ 480–486 34.7 36.2 38.1 42.2 42.5 43.4 41.8

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 18.1 19.5 19.7 19.4 19.2 19.6 18.3

Diseases of the digestive system ........................... 520–579 206.1 164.0 134.6 134.4 130.7 129.9 125.7

Ulcers of the stomach and small intestine ..................... 531–534 16.1 12.4 10.5 10.4 9.8 9.5 9.1

Appendicitis ....................................... 540–543 11.8 10.6 10.0 9.3 9.6 9.2 9.0

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 22.6 16.3 10.6 8.7 6.8 5.4 4.4

Noninfectious enteritis and colitis .......................... 555–558 27.5 20.1 14.9 15.4 15.1 14.0 13.9

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 20.3 20.0 19.9 19.7 20.4 22.0 20.2

Diseases of the genitourinary system ......................... 580–629 159.5 118.8 90.8 89.4 87.8 82.7 79.6

Calculus of kidney and ureter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 13.7 13.8 11.8 11.3 11.0 9.6 8.6

Hyperplasia of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600 12.2 10.4 10.2 10.1 10.5 9.2 8.7

Complications of pregnancy, childbirth, and the puerperium1 ........... 630–676 44.8 41.0 34.5 30.8 29.6 28.8 26.1

Abortions and ectopic and molar pregnancies .................. 630–639 23.5 16.2 10.9 9.4 8.4 7.2 7.0

Diseases of the skin and subcutaneous tissue ................... 680–709 26.5 22.9 18.9 19.6 18.6 18.4 18.2

Cellulitis and abscess ................................. 681–682 8.9 10.9 11.5 12.3 11.6 11.9 12.1

Diseases of the musculoskeletal system and connective tissue ......... 710–739 99.5 91.9 67.8 64.0 64.3 63.9 63.5

Arthropathies and related disorders ......................... 710–719 24.1 19.7 18.9 17.6 19.4 21.0 21.9

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 17.1 21.5 17.2 16.2 17.1 15.6 16.0

Congenital anomalies ................................... 740–759 15.2 11.4 9.3 8.4 7.4 7.7 7.6

Certain conditions originating in the perinatal period ................ 760–779 4.0 6.7 6.5 6.2 6.6 5.9 5.6

Symptoms, signs, and ill-defined conditions ..................... 780–799 28.2 22.6 16.4 15.5 16.6 15.4 13.8

Injury and poisoning ................................... 800–999 159.2 139.8 116.0 114.5 112.0 110.5 106.6

Fractures, all sites ................................... 800–829 51.5 47.8 41.8 41.7 41.0 41.3 40.1

Fracture of neck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820 9.3 10.9 10.5 10.8 11.3 12.0 11.0

Intracranial injuries (excluding those with skull fracture) ............ 850–854 13.1 11.4 8.3 7.6 7.4 7.2 6.0

Lacerations and open wounds ............................ 870–904 14.8 11.7 9.6 9.2 9.7 7.7 7.1

Supplementary classifications .............................. V01–V82 195.9 183.1 176.9 181.3 181.9 177.1 172.9

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V27 166.8 163.2 155.7 160.6 162.5 158.6 154.2

1The first-listed diagnoses for females with deliveries is coded V27, shown under ‘‘Supplementary classifications.’’

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

30
Table 10. Number of days of care for discharges from short-stay hospitals by first-listed diagnosis: United States, 1980, 1985, and

1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code numbers are based on the International Classification of

Diseases, 9th Revision, Clinical Modifications (ICD–9–CM)]

First-listed diagnosis and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Number of days of care in thousands

All conditions .............................................. 274,508 226,217 203,678 200,827 197,422 199,099 190,386

Infectious and parasitic diseases ............................ 001–139 4,509 4,664 5,603 5,560 6,725 6,432 6,401

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 038 849 1,770 2,484 2,173 2,858 2,790 3,014

Neoplasms ......................................... 140–239 26,004 19,740 17,792 16,692 16,771 16,414 15,379

Malignant neoplasms ............................ 140–208,230–234 22,273 17,001 15,676 14,843 14,693 14,602 13,433

Malignant neoplasms of large intestine and rectum ........... 153–154,197.5 3,143 2,430 2,150 2,337 2,402 2,448 1,848

Malignant neoplasm of trachea, bronchus, and lung ......... 162,197.0,197.3 3,561 2,884 2,233 2,068 1,961 2,034 1,783

Malignant neoplasm of breast ....................... 174–175,198.81 2,330 1,489 990 882 751 695 695

Benign neoplasms and neoplasms of uncertain behavior and unspecified

nature ..................................... 210–229,235–239 3,731 2,740 2,117 1,849 2,078 1,812 1,947

Endocrine, nutritional and metabolic diseases, and immunity disorders .... 240–279 10,972 7,845 7,784 7,514 7,610 8,092 7,488

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 6,754 3,901 3,734 3,308 3,295 3,043 3,274

Volume depletion ...................................... 276.5 895 1,481 1,879 1,931 2,085 2,479 1,985

Diseases of the blood and blood-forming organs .................. 280–289 2,420 2,050 1,826 1,907 1,877 2,163 1,950

Mental disorders ...................................... 290–319 19,578 20,956 20,339 19,254 18,824 18,966 18,581

Psychoses ........................................ 290–299 7,480 10,435 11,812 11,194 11,861 12,153 11,746

Alcohol dependence syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 4,424 4,169 2,643 2,312 2,366 2,167 2,438

Diseases of the nervous system and sense organs ................ 320–389 9,597 6,595 4,988 4,527 4,268 4,271 3,907

Diseases of the central nervous system ................. 320–336,340–349 4,372 4,092 3,276 2,937 2,955 2,924 2,772

Diseases of the ear and mastoid process ..................... 380–389 1,277 729 499 461 437 409 381

Diseases of the circulatory system .......................... 390–459 51,431 43,144 39,927 39,291 37,899 38,965 39,379

Heart disease .............. 391–392.0,393–398,402,404,410–416,420–429 30,500 26,082 25,883 24,706 24,557 25,279 26,256

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 5,432 7,152 6,432 5,947 5,674 5,666 6,058

Coronary atherosclerosis ................................ 414.0 5,625 2,016 2,502 2,521 2,393 2,735 2,342

Other ischemic heart disease . . . . . . . . . . . . . . . . . . . 411–413,414.1–414.9 6,078 5,379 4,871 4,661 4,503 4,423 4,831

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 2,963 3,148 2,758 2,805 2,795 2,825 2,835

Congestive heart failure ................................ 428.0 4,154 4,459 5,560 5,387 5,604 6,070 6,506

Cerebrovascular disease .............................. 430–438 10,114 9,600 7,611 8,130 7,727 7,805 7,302

Diseases of the respiratory system .......................... 460–519 21,649 19,583 19,435 20,133 20,433 20,651 19,753

Acute respiratory infections .............................. 460–466 2,439 2,073 2,282 2,341 2,494 2,467 1,495

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . 474 870 437 241 160 128 91 95

Pneumonia ........................................ 480–486 6,497 6,788 7,801 8,343 8,744 8,954 8,793

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 2,435 2,275 2,279 2,130 2,222 2,224 2,008

Diseases of the digestive system ........................... 520–579 32,342 23,950 20,179 20,727 19,197 19,347 18,404

Ulcers of the stomach and small intestine ..................... 531–534 3,101 2,088 1,850 1,882 1,593 1,643 1,607

Appendicitis ....................................... 540–543 1,457 1,248 1,254 1,113 1,044 982 1,009

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 2,404 1,231 636 547 383 324 280

Noninfectious enteritis and colitis .......................... 555–558 3,459 2,372 2,031 2,069 1,814 1,948 1,732

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 4,254 3,558 3,162 3,055 2,925 2,745 2,236

Diseases of the genitourinary system ......................... 580–629 20,068 14,531 11,600 11,451 10,989 10,011 9,448

Calculus of kidney and ureter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 1,542 1,217 884 847 838 663 678

Hyperplasia of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600 2,459 1,572 1,550 1,299 1,283 1,215 971

Complications of pregnancy, childbirth, and the puerperium1 ........... 630–676 2,531 2,461 2,286 2,119 1,913 2,105 1,703

Abortions and ectopic and molar pregnancies .................. 630–639 1,129 821 609 531 438 432 352

Diseases of the skin and subcutaneous tissue ................... 680–709 4,803 4,292 3,710 3,857 3,670 3,889 3,583

Cellulitis and abscess ................................. 681–682 1,618 1,968 1,963 2,208 2,059 2,121 2,070

Diseases of the musculoskeletal system and connective tissue ......... 710–739 18,679 14,609 10,403 10,231 10,222 10,224 10,017

Arthropathies and related disorders ......................... 710–719 5,090 3,584 3,416 3,321 3,752 3,891 4,027

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 3,791 3,693 2,466 2,149 2,167 1,955 1,786

Congenital anomalies ................................... 740–759 2,265 1,506 1,349 1,211 1,099 1,187 1,212

Certain conditions originating in the perinatal period ................ 760–779 787 2,062 1,968 1,720 1,657 1,572 1,743

Symptoms, signs, and ill-defined conditions ..................... 780–799 2,897 2,023 1,319 1,243 1,163 1,168 1,038

Injury and poisoning ................................... 800–999 27,640 21,917 19,147 19,086 18,891 19,138 16,856

Fractures, all sites ................................... 800–829 12,583 9,864 8,558 8,691 8,435 8,733 7,842

Fracture of neck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820 4,333 3,784 3,405 3,492 3,610 3,692 3,250

Intracranial injuries (excluding those with skull fracture) ............ 850–854 1,665 1,497 1,108 1,302 1,016 1,041 839

Lacerations and open wounds ............................ 870–904 1,720 1,196 957 838 1,031 940 684

Supplementary classifications .............................. V01–V82 16,337 14,288 14,023 14,303 14,212 14,504 13,542

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V27 14,158 12,640 11,029 11,468 11,225 11,028 10,040

1The first-listed diagnoses for females with deliveries is coded V27, shown under ‘‘Supplementary classifications.’’

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

31
Table 11. Rate of days of care for discharges from short-stay hospitals by first-listed diagnosis: United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code numbers are based on the International Classification of

Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

First-listed diagnosis and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Rate of days of care per 10,000 population

All conditions .............................................. 12,166.8 9,576.6 8,388.1 8,192.6 7,968.6 7,946.0 7,510.4

Infectious and parasitic diseases ............................ 001–139 199.9 197.5 230.8 226.8 271.4 256.7 252.5

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 038 37.6 75.0 102.3 88.6 115.4 111.3 118.9

Neoplasms ......................................... 140–239 1,152.6 835.7 732.7 680.9 676.9 655.1 606.7

Malignant neoplasms ............................ 140–208,230–234 987.2 719.7 645.6 605.5 593.0 582.8 529.9

Malignant neoplasm of large intestine and rectum ........... 153–154,197.5 139.3 102.9 88.6 95.3 96.9 97.7 72.9

Malignant neoplasm of trachea, bronchus, and lung ......... 162,197.0,197.3 157.8 122.1 92.0 84.4 79.2 81.2 70.3

Malignant neoplasm of breast ....................... 174–175,198.81 103.3 63.1 40.8 36.0 30.3 27.8 27.4

Benign neoplasms and neoplasms of uncertain behavior and unspecified

nature .................................... 210–229,235–239 165.4 116.0 87.2 75.4 83.9 72.3 76.8

Endocrine, nutritional and metabolic diseases, and immunity disorders .... 240–279 486.3 332.1 320.6 306.5 307.2 322.9 295.4

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 299.4 165.1 153.8 134.9 133.0 121.4 129.2

Volume depletion ...................................... 276.5 39.7 62.7 77.4 78.8 84.1 98.9 78.3

Diseases of the blood and blood-forming organs .................. 280–289 107.3 86.8 75.2 77.8 75.8 86.3 76.9

Mental disorders ...................................... 290–319 867.8 887.1 837.6 785.4 759.8 756.9 733.0

Psychoses ........................................ 290–299 331.5 441.7 486.5 456.6 478.7 485.0 463.3

Alcohol dependence syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 196.1 176.5 108.9 94.3 95.5 86.5 96.2

Diseases of the nervous system and sense organs ................ 320–389 425.4 279.2 205.4 184.7 172.3 170.4 154.1

Diseases of the central nervous system ................. 320–336,340–349 193.8 173.2 134.9 119.8 119.3 116.7 109.3

Diseases of the ear and mastoid process ..................... 380–389 56.6 30.8 20.6 18.8 17.6 16.3 15.0

Diseases of the circulatory system .......................... 390–459 2,279.5 1,826.4 1,644.3 1,602.9 1,529.7 1,555.1 1,553.4

Heart disease .............. 391–392.0,393–398,402,404,410–416,420–429 1,351.8 1,104.2 1,065.9 1,007.9 991.2 1,008.9 1,035.7

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 240.7 302.8 264.9 242.6 229.0 226.1 239.0

Coronary atherosclerosis ................................ 414.0 249.3 85.3 103.0 102.8 96.6 109.1 92.4

Other ischemic heart disease . . . . . . . . . . . . . . . . . . . 411–413,414.1–414.9 269.4 227.7 200.6 190.1 181.8 176.5 190.6

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 131.3 133.3 113.6 114.4 112.8 112.7 111.8

Congestive heart failure ................................ 428.0 184.1 188.8 229.0 219.8 226.2 242.2 256.7

Cerebrovascular disease ............................... 430–438 448.3 406.4 313.5 331.7 311.9 311.5 288.0

Diseases of the respiratory system .......................... 460–519 959.5 829.0 800.4 821.3 824.8 824.2 779.2

Acute respiratory infections .............................. 460–466 108.1 87.8 94.0 95.5 100.6 98.5 59.0

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . 474 38.6 18.5 9.9 6.5 5.2 3.6 3.8

Pneumonia ........................................ 480–486 288.0 287.3 321.3 340.4 352.9 357.4 346.8

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 107.9 96.3 93.9 86.9 89.7 88.8 79.2

Diseases of the digestive system ........................... 520–579 1,433.5 1,013.9 831.1 845.6 774.9 772.1 726.0

Ulcers of the stomach and small intestine ..................... 531–534 137.4 88.4 76.2 76.8 64.3 65.6 63.4

Appendicitis ....................................... 540–543 64.6 52.9 51.6 45.4 42.2 39.2 39.8

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 106.5 52.1 26.2 22.3 15.5 12.9 11.0

Noninfectious enteritis and colitis .......................... 555–558 153.3 100.4 83.6 84.4 73.2 77.7 68.3

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 188.5 150.6 130.2 124.6 118.1 109.6 88.2

Diseases of the genitourinary system ......................... 580–629 889.4 615.1 477.7 467.1 443.5 399.5 372.7

Calculus of kidney and ureter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 68.3 51.5 36.4 34.5 33.8 26.5 26.7

Hyperplasia of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600 109.0 66.6 63.8 53.0 51.8 48.5 38.3

Complications of pregnancy, childbirth, and the puerperium1 ........... 630–676 112.2 104.2 94.1 86.5 77.2 84.0 67.2

Abortions and ectopic and molar pregnancies .................. 630–639 50.0 34.8 25.1 21.7 17.7 17.2 13.9

Diseases of the skin and subcutaneous tissue ................... 680–709 212.9 181.7 152.8 157.4 148.1 155.2 141.3

Cellulitis and abscess ................................. 681–682 71.7 83.3 80.8 90.1 83.1 84.6 81.6

Diseases of the musculoskeletal system and connective tissue ......... 710–739 827.9 618.5 428.4 417.4 412.6 408.0 395.2

Arthropathies and related disorders ......................... 710–719 225.6 151.7 140.7 135.5 151.4 155.3 158.9

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 168.0 156.4 101.6 87.7 87.4 78.0 70.5

Congenital anomalies ................................... 740–759 100.4 63.7 55.6 49.4 44.4 47.4 47.8

Certain conditions originating in the perinatal period ................ 760–779 34.9 87.3 81.0 70.2 66.9 62.8 68.7

Symptoms, signs, and ill-defined conditions ..................... 780–799 128.4 85.7 54.3 50.7 47.0 46.6 40.9

Injury and poisoning ................................... 800–999 1,225.0 927.8 788.5 778.6 762.5 763.8 664.9

Fractures, all sites ................................... 800–829 557.7 417.6 352.4 354.5 340.5 348.5 309.3

Fracture of neck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820 192.1 160.2 140.2 142.5 145.7 147.3 128.2

Intracranial injuries (excluding those with skull fracture) ............ 850–854 73.8 63.4 45.6 53.1 41.0 41.6 33.1

Lacerations and open wounds ............................ 870–904 76.2 50.6 39.4 34.2 41.6 37.5 27.0

Supplementary classifications .............................. V01-V82 724.1 604.8 577.5 583.5 573.6 578.9 534.2

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V27 627.5 535.1 454.2 467.8 453.1 440.1 396.1

1The first-listed diagnoses for females with deliveries is coded V27, shown under ‘‘Supplementary classifications.’’

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

32
Table 12. Average length of stay for discharges from short-stay hospitals by first-listed diagnosis: United States, 1980, 1985, and

1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code numbers are based on the International Classification of

Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

First-listed diagnosis and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Average length of stay in days

All conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 6.5 6.5 6.5 6.4 6.4 6.2

Infectious and parasitic diseases ............................ 001–139 6.9 7.0 8.1 7.7 9.1 8.5 7.9

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 038 14.3 11.9 12.8 11.1 13.3 11.6 10.8

Neoplasms ......................................... 140–239 10.5 8.2 8.5 8.3 8.5 8.2 7.7

Malignant neoplasms ............................ 140–208,230–234 11.9 8.9 9.4 9.2 9.4 9.2 8.5

Malignant neoplasm of large intestine and rectum ........... 153–154,197.5 15.7 12.3 13.1 14.0 13.7 14.6 11.5

Malignant neoplasm of trachea, bronchus, and lung ......... 162,197.0,197.3 12.8 9.2 9.5 8.6 8.5 8.6 8.3

Malignant neoplasm of breast ....................... 174–175,198.81 10.9 7.2 5.6 5.4 4.6 4.4 4.1

Benign neoplasms and neoplasms of uncertain behavior and unspecified

nature .................................... 210–229,235–239 6.2 5.5 4.9 4.7 5.3 4.5 4.6

Endocrine, nutritional and metabolic diseases, and immunity disorders .... 240–279 9.6 7.3 7.5 6.8 7.0 7.1 6.4

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 10.5 8.1 8.2 7.6 7.8 7.1 6.9

Volume depletion ...................................... 276.5 8.9 6.2 7.1 6.8 6.5 7.5 6.4

Diseases of the blood and blood-forming organs .................. 280–289 7.2 6.0 6.2 6.0 5.8 6.2 6.0

Mental disorders ...................................... 290–319 11.6 12.3 13.0 12.7 12.2 11.4 10.9

Psychoses ........................................ 290–299 14.8 14.9 15.1 14.5 14.6 13.5 12.9

Alcohol dependence syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 10.1 10.7 11.2 10.6 9.9 9.5 9.4

Diseases of the nervous system and sense organs ................ 320–389 5.4 5.4 5.4 5.5 5.5 5.7 5.5

Diseases of the central nervous system ................. 320–336,340–349 10.7 9.6 9.4 8.6 8.6 8.8 8.8

Diseases of the ear and mastoid process ..................... 380–389 3.1 2.8 2.5 2.6 2.8 2.8 2.6

Diseases of the circulatory system .......................... 390–459 10.0 7.9 7.5 7.6 7.3 7.3 7.0

Heart disease .............. 391–392.0,393–398,402,404,410–416,420–429 9.5 7.3 7.1 7.0 6.9 6.8 6.7

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 12.6 9.5 9.0 8.6 8.4 8.1 8.1

Coronary atherosclerosis ................................ 414.0 10.0 6.6 6.1 6.2 5.8 7.1 5.6

Other ischemic heart disease . . . . . . . . . . . . . . . . . . . 411–413,414.1–414.9 7.7 5.4 5.3 5.2 5.2 5.0 5.0

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 7.6 6.2 5.6 5.8 5.8 5.3 5.2

Congestive heart failure ................................ 428.0 10.4 8.0 8.8 8.4 8.0 7.9 7.9

Cerebrovascular disease ............................... 430–438 12.7 10.5 9.7 10.2 9.5 9.3 8.8

Diseases of the respiratory system .......................... 460–519 6.3 6.0 6.6 6.7 6.9 6.8 6.8

Acute respiratory infections .............................. 460–466 4.7 4.5 5.1 4.9 5.1 4.8 4.0

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . 474 1.9 1.5 1.2 1.2 1.3 1.2 1.3

Pneumonia ........................................ 480–486 8.3 7.9 8.4 8.1 8.3 8.2 8.3

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 6.0 4.9 4.8 4.5 4.7 4.5 4.3

Diseases of the digestive system ........................... 520–579 7.0 6.2 6.2 6.3 5.9 5.9 5.8

Ulcers of the stomach and small intestine ..................... 531–534 8.6 7.1 7.2 7.3 6.5 6.9 6.9

Appendicitis ....................................... 540–543 5.5 5.0 5.2 4.9 4.4 4.2 4.4

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 4.7 3.2 2.5 2.6 2.3 2.4 2.5

Noninfectious enteritis and colitis .......................... 555–558 5.6 5.0 5.6 5.5 4.9 5.6 4.9

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 9.3 7.5 6.5 6.3 5.8 5.0 4.4

Diseases of the genitourinary system ......................... 580–629 5.6 5.2 5.3 5.2 5.1 4.8 4.7

Calculus of kidney and ureter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 5.0 3.7 3.1 3.0 3.1 2.7 3.1

Hyperplasia of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600 8.9 6.4 6.3 5.2 4.9 5.3 4.4

Complications of pregnancy, childbirth, and the puerperium1 ........... 630–676 2.5 2.5 2.7 2.8 2.6 2.9 2.6

Abortions and ectopic and molar pregnancies .................. 630–639 2.1 2.1 2.3 2.3 2.1 2.4 2.0

Diseases of the skin and subcutaneous tissue ................... 680–709 8.0 7.9 8.1 8.0 7.9 8.4 7.8

Cellulitis and abscess ................................. 681–682 8.0 7.7 7.0 7.3 7.2 7.1 6.7

Diseases of the musculoskeletal system and connective tissue ......... 710–739 8.3 6.7 6.3 6.5 6.4 6.4 6.2

Arthropathies and related disorders ......................... 710–719 9.4 7.7 7.4 7.7 7.8 7.4 7.3

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 9.9 7.3 5.9 5.4 5.1 5.0 4.4

Congenital anomalies ................................... 740–759 6.6 5.6 5.9 5.9 6.0 6.2 6.3

Certain conditions originating in the perinatal period ................ 760–779 8.7 13.0 12.4 11.3 10.2 10.7 12.4

Symptoms, signs, and ill-defined conditions ..................... 780–799 4.5 3.8 3.3 3.3 2.8 3.0 3.0

Injury and poisoning ................................... 800–999 7.7 6.6 6.8 6.8 6.8 6.9 6.2

Fractures, all sites ................................... 800–829 10.8 8.7 8.4 8.5 8.3 8.4 7.7

Fracture of neck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820 20.6 14.7 13.4 13.2 12.8 12.3 11.7

Intracranial injuries (excluding those with skull fracture) ............ 850–854 5.6 5.6 5.5 7.0 5.5 5.8 5.5

Lacerations and open wounds ............................ 870–904 5.1 4.3 4.1 3.7 4.3 4.9 3.8

Supplementary classifications .............................. V01–V82 3.7 3.3 3.3 3.2 3.2 3.3 3.1

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V27 3.8 3.3 2.9 2.9 2.8 2.8 2.6

1The first-listed diagnoses for females with deliveries is coded V27, shown under ‘‘Supplementary classifications.’’

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

33
Table 13. Number of male discharges from short-stay hospitals by first-listed diagnosis: United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code numbers are based on the International Classification of

Diseases, 9th Revision, Clinical Modifications (ICD–9–CM)]

First-listed diagnosis and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Number of male discharges in thousands

All conditions .............................................. 15,145 14,160 12,642 12,583 12,280 12,478 12,406

Infectious and parasitic diseases ............................ 001–139 309 308 333 362 356 363 403

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 038 28 64 86 96 99 103 131

Neoplasms ......................................... 140–239 1,028 1,008 851 842 804 860 845

Malignant neoplasms ............................ 140–208,230–234 878 892 772 770 730 781 765

Malignant neoplasm of large intestine and rectum ........... 153–154,197.5 91 93 77 84 85 86 78

Malignant neoplasm of trachea, bronchus, and lung ......... 162,197.0,197.3 193 206 136 147 141 147 124

Malignant neoplasm of breast ....................... 174–175,198.81 *******

Benign neoplasms and neoplasms of uncertain behavior and unspecified

nature .................................... 210–229,235–239 150 116 78 72 74 78 79

Endocrine, nutritional and metabolic diseases, and immunity disorders .... 240–279 396 409 414 453 436 437 487

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 245 194 209 197 190 185 207

Volume depletion ...................................... 276.5 35 93 102 126 127 121 122

Diseases of the blood and blood-forming organs .................. 280–289 145 149 140 154 158 167 137

Mental disorders ...................................... 290–319 885 918 765 778 777 840 868

Psychoses ........................................ 290–299 248 325 341 351 360 416 408

Alcohol dependence syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 342 312 179 165 184 172 196

Diseases of the nervous system and sense organs ................ 320–389 794 537 430 364 356 352 330

Diseases of the central nervous system ................. 320–336,340–349 194 196 169 158 155 160 147

Diseases of the ear and mastoid process ..................... 380–389 205 117 99 87 77 72 72

Diseases of the circulatory system .......................... 390–459 2,590 2,783 2,722 2,670 2,668 2,728 2,866

Heart disease .............. 391–392.0,393–398,402,404,410–416,420–429 1,688 1,910 1,955 1,892 1,913 1,977 2,083

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 272 466 451 421 413 422 458

Coronary atherosclerosis ................................ 414.0 303 190 278 282 277 263 285

Other ischemic heart disease . . . . . . . . . . . . . . . . . . . 411–413,414.1–414.9 474 549 491 471 465 461 505

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 185 244 228 220 244 249 256

Congestive heart failure ................................ 428.0 176 247 277 304 315 360 373

Cerebrovascular disease ............................... 430–438 371 416 336 344 359 370 375

Diseases of the respiratory system .......................... 460–519 1,755 1,591 1,464 1,507 1,430 1,508 1,436

Acute respiratory infections .............................. 460–466 251 236 224 244 235 258 187

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . 474 192 124 87 58 41 32 32

Pneumonia ........................................ 480–486 414 433 472 544 530 545 535

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 180 195 210 204 191 221 201

Diseases of the digestive system ........................... 520–579 2,171 1,839 1,515 1,501 1,449 1,455 1,392

Ulcers of the stomach and small intestine ..................... 531–534 191 156 137 134 131 125 115

Appendicitis ....................................... 540–543 145 143 141 135 138 129 135

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 458 343 232 193 149 120 98

Noninfectious enteritis and colitis .......................... 555–558 255 197 132 150 151 142 134

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 115 140 132 132 132 159 154

Diseases of the genitourinary system ......................... 580–629 1,100 958 828 851 803 781 730

Calculus of kidney and ureter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 210 215 183 180 177 160 143

Hyperplasia of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600 276 246 247 249 259 229 221

Diseases of the skin and subcutaneous tissue ................... 680–709 288 268 234 238 234 245 230

Cellulitis and abscess ................................. 681–682 110 141 145 149 151 165 158

Diseases of the musculoskeletal system and connective tissue ......... 710–739 971 939 774 745 735 738 714

Arthropathies and related disorders ......................... 710–719 215 188 191 193 197 228 212

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 212 281 247 219 241 225 222

Congenital anomalies ................................... 740–759 167 156 128 112 105 101 102

Certain conditions originating in the perinatal period ................ 760–779 52 82 92 88 93 79 81

Symptoms, signs, and ill-defined conditions ..................... 780–799 291 260 200 191 201 202 173

Injury and poisoning ................................... 800–999 2,025 1,800 1,535 1,514 1,476 1,437 1,405

Fractures, all sites ................................... 800–829 582 550 506 480 466 481 465

Fracture of neck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820 52 62 68 61 72 80 73

Intracranial injuries (excluding those with skull fracture) ............ 850–854 179 162 124 114 112 106 97

Lacerations and open wounds ............................ 870–904 255 203 176 171 179 137 130

Supplementary classifications .............................. V01–V82 178 156 217 214 198 188 207

* Figure does not meet standard of reliability or precision.

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

34
Table 14. Rate of male discharges from short-stay hospitals by first-listed diagnosis: United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code numbers are based on the International Classification of

Diseases, 9th Revision, Clinical Modifications (ICD–9–CM)]

First-listed diagnosis and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Rate of male discharges per 10,000 population

All conditions .............................................. 1,390.4 1,240.2 1,075.3 1,059.5 1,022.2 1,026.7 1,008.0

Infectious and parasitic diseases ............................ 001–139 28.4 27.0 28.3 30.5 29.7 29.8 32.8

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 038 2.5 5.6 7.3 8.1 8.3 8.5 10.6

Neoplasms ......................................... 140–239 94.4 88.2 72.4 70.9 66.9 70.7 68.6

Malignant neoplasms ............................ 140–208,230–234 80.6 78.1 65.7 64.8 60.8 64.3 62.2

Malignant neoplasm of large intestine and rectum ........... 153–154,197.5 8.4 8.2 6.6 7.1 7.0 7.0 6.3

Malignant neoplasm of trachea, bronchus, and lung ......... 162,197.0,197.3 17.7 18.0 11.5 12.4 11.8 12.1 10.1

Malignant neoplasm of breast ....................... 174–175,198.81 *******

Benign neoplasms and neoplasms of uncertain behavior and unspecified

nature ..................................... 210–229,235–239 13.7 10.2 6.7 6.1 6.2 6.4 6.4

Endocrine, nutritional and metabolic diseases, and immunity disorders .... 240–279 36.3 35.8 35.2 38.1 36.3 35.9 39.5

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 22.5 17.0 17.7 16.6 15.8 15.2 16.8

Volume depletion ...................................... 276.5 3.2 8.1 8.7 10.6 10.6 10.0 9.9

Diseases of the blood and blood-forming organs .................. 280–289 13.3 13.0 11.9 12.9 13.2 13.7 11.2

Mental disorders ...................................... 290–319 81.3 80.4 65.1 65.5 64.7 69.1 70.5

Psychoses ........................................ 290–299 22.7 28.5 29.0 29.5 30.0 34.2 33.2

Alcohol dependence syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 31.4 27.4 15.2 13.9 15.3 14.2 15.9

Diseases of the nervous system and sense organs ................ 320–389 72.9 47.0 36.6 30.6 29.6 28.9 26.8

Diseases of the central nervous system ................. 320–336,340–349 17.8 17.2 14.4 13.3 12.9 13.1 11.9

Diseases of the ear and mastoid process ..................... 380–389 18.8 10.3 8.4 7.3 6.4 6.0 5.8

Diseases of the circulatory system .......................... 390–459 237.8 243.8 231.5 224.8 222.1 224.4 232.9

Heart disease .............. 391–392.0,393–398,402,404,410–416,420–429 155.0 167.3 166.3 159.3 159.3 162.6 169.3

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 25.0 40.8 38.4 35.4 34.4 34.7 37.2

Coronary atherosclerosis ................................ 414.0 27.8 16.7 23.6 23.7 23.0 21.7 23.2

Other ischemic heart disease . . . . . . . . . . . . . . . . . . . 411–413,414.1–414.9 43.5 48.1 41.7 39.7 38.7 37.9 41.0

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 17.0 21.4 19.4 18.5 20.3 20.5 20.8

Congestive heart failure ................................ 428.0 16.2 21.6 23.6 25.6 26.2 29.6 30.3

Cerebrovascular disease ............................... 430–438 34.0 36.4 28.5 29.0 29.9 30.4 30.5

Diseases of the respiratory system .......................... 460–519 161.1 139.3 124.5 126.9 119.0 124.1 116.7

Acute respiratory infections .............................. 460–466 23.0 20.6 19.1 20.6 19.6 21.2 15.2

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . 474 17.7 10.8 7.4 4.9 3.4 2.6 2.6

Pneumonia ........................................ 480–486 38.1 37.9 40.2 45.8 44.1 44.8 43.5

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 16.6 17.1 17.8 17.2 15.9 18.2 16.3

Diseases of the digestive system ........................... 520–579 199.3 161.0 128.8 126.4 120.7 119.7 113.1

Ulcers of the stomach and small intestine ..................... 531–534 17.5 13.6 11.7 11.3 10.9 10.3 9.3

Appendicitis ....................................... 540–543 13.3 12.5 12.0 11.4 11.5 10.6 11.0

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 42.0 30.0 19.7 16.2 12.4 9.9 7.9

Noninfectious enteritis and colitis .......................... 555–558 23.4 17.3 11.2 12.6 12.5 11.7 10.9

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 10.6 12.3 11.2 11.1 11.0 13.1 12.5

Diseases of the genitourinary system ......................... 580–629 101.0 83.9 70.4 71.7 66.8 64.2 59.3

Calculus of kidney and ureter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 19.3 18.8 15.6 15.2 14.7 13.2 11.6

Hyperplasia of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600 25.3 21.5 21.0 20.9 21.6 18.9 18.0

Diseases of the skin and subcutaneous tissue ................... 680–709 26.5 23.5 19.9 20.0 19.5 20.1 18.7

Cellulitis and abscess ................................. 681–682 10.1 12.4 12.3 12.5 12.6 13.6 12.9

Diseases of the musculoskeletal system and connective tissue ......... 710–739 89.2 82.3 65.9 62.7 61.2 60.7 58.0

Arthropathies and related disorders ......................... 710–719 19.8 16.5 16.3 16.3 16.4 18.7 17.2

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 19.5 24.6 21.0 18.5 20.1 18.5 18.0

Congenital anomalies ................................... 740–759 15.3 13.7 10.9 9.4 8.8 8.3 8.3

Certain conditions originating in the perinatal period ................ 760–779 4.8 7.2 7.8 7.4 7.7 6.5 6.6

Symptoms, signs, and ill-defined conditions ..................... 780–799 26.8 22.7 17.0 16.0 16.7 16.6 14.0

Injury and poisoning ................................... 800–999 185.9 157.6 130.6 127.5 122.9 118.2 114.1

Fractures, all sites ................................... 800–829 53.5 48.2 43.0 40.5 38.8 39.6 37.8

Fracture of neck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820 4.7 5.5 5.8 5.2 6.0 6.6 5.9

Intracranial injuries (excluding those with skull fracture) ............ 850–854 16.5 14.2 10.5 9.6 9.3 8.7 7.9

Lacerations and open wounds ............................ 870–904 23.4 17.8 15.0 14.4 14.9 11.3 10.5

Supplementary classifications .............................. V01–V82 16.4 13.6 18.4 18.0 16.5 15.5 16.8

*Figure does not meet standard of reliability or precision.

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

35
Table 15. Number of female discharges from short-stay hospitals by first-listed diagnosis: United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code numbers are based on the International Classification of

Diseases, 9th Revision, Clinical Modifications (ICD–9–CM)]

First-listed diagnosis and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Number of female discharges in thousands

All conditions .............................................. 22,686 20,896 18,504 18,364 18,508 18,620 18,545

Infectious and parasitic diseases ............................ 001–139 340 361 359 363 380 396 404

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 038 32 85 108 100 116 137 148

Neoplasms ......................................... 140–239 1,448 1,403 1,247 1,159 1,161 1,141 1,154

Malignant neoplasms ............................ 140–208,230–234 994 1,019 898 838 841 812 812

Malignant neoplasm of large intestine and rectum ........... 153–154,197.5 109 104 87 83 90 82 83

Malignant neoplasm of trachea, bronchus, and lung ......... 162,197.0,197.3 84 110 100 92 90 89 91

Malignant neoplasm of breast ....................... 174–175,198.81 212 207 176 162 163 156 169

Benign neoplasms and neoplasms of uncertain behavior and unspecified

nature ..................................... 210–229,235–239 454 384 350 320 319 329 342

Endocrine, nutritional and metabolic diseases, and immunity disorders .... 240–279 750 659 623 644 653 706 691

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 400 286 245 241 230 245 269

Volume depletion ...................................... 276.5 65 147 163 159 192 208 186

Diseases of the blood and blood-forming organs .................. 280–289 191 193 155 164 166 181 185

Mental disorders ...................................... 290–319 807 782 793 736 761 817 843

Psychoses ........................................ 290–299 259 376 440 422 452 486 500

Alcohol dependence syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 97 76 58 53 55 56 63

Diseases of the nervous system and sense organs ................ 320–389 968 674 492 455 414 404 378

Diseases of the central nervous system ................. 320–336,340–349 214 229 179 183 187 171 167

Diseases of the ear and mastoid process ..................... 380–389 200 142 102 90 81 72 73

Diseases of the circulatory system .......................... 390–459 2,549 2,686 2,574 2,527 2,493 2,611 2,730

Heart disease .............. 391–392.0,393–398,402,404,410–416,420–429 1,513 1,674 1,686 1,642 1,643 1,727 1,852

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 159 289 265 274 261 275 289

Coronary atherosclerosis ................................ 414.0 259 114 134 125 133 121 130

Other ischemic heart disease . . . . . . . . . . . . . . . . . . . 411–413,414.1–414.9 319 443 431 422 406 415 467

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 204 267 263 267 239 287 286

Congestive heart failure ................................ 428.0 224 310 357 339 386 405 449

Cerebrovascular disease ............................... 430–438 425 500 448 451 452 466 454

Diseases of the respiratory system .......................... 460–519 1,691 1,647 1,473 1,489 1,536 1,544 1,486

Acute respiratory infections .............................. 460–466 272 229 221 230 252 261 189

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . 474 265 164 110 76 61 44 41

Pneumonia ........................................ 480–486 368 421 452 489 522 543 524

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 228 266 270 271 285 269 263

Diseases of the digestive system ........................... 520–579 2,479 2,034 1,753 1,794 1,790 1,801 1,795

Ulcers of the stomach and small intestine ..................... 531–534 172 137 118 122 113 112 117

Appendicitis ....................................... 540–543 122 107 101 92 101 103 92

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 51 42 25 20 18 14 14

Noninfectious enteritis and colitis .......................... 555–558 366 277 230 228 223 209 220

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 342 333 352 351 374 393 358

Diseases of the genitourinary system ......................... 580–629 2,500 1,848 1,376 1,340 1,373 1,291 1,289

Calculus of kidney and ureter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 99 110 104 98 95 81 75

Complications of pregnancy, childbirth, and the puerperium1 ........... 630–676 1,010 968 837 756 734 723 662

Abortions and ectopic and molar pregnancies .................. 630–639 531 382 266 229 208 180 179

Diseases of the skin and subcutaneous tissue ................... 680–709 309 273 226 242 228 217 232

Cellulitis and abscess ................................. 681–682 92 115 135 154 137 132 148

Diseases of the musculoskeletal system and connective tissue ......... 710–739 1,273 1,231 872 825 857 862 896

Arthropathies and related disorders ......................... 710–719 328 276 267 237 283 298 342

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 172 227 170 177 183 166 185

Congenital anomalies ................................... 740–759 177 113 98 95 77 91 89

Certain conditions originating in the perinatal period ................ 760–779 39 77 66 63 70 68 60

Symptoms, signs, and ill-defined conditions ..................... 780–799 346 275 198 190 209 184 177

Injury and poisoning ................................... 800–999 1,568 1,503 1,281 1,292 1,298 1,331 1,296

Fractures, all sites ................................... 800–829 580 579 508 541 551 553 552

Fracture of neck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820 158 196 186 204 209 219 205

Intracranial injuries (excluding those with skull fracture) ............ 850–854 116 107 78 73 72 74 56

Lacerations and open wounds ............................ 870–904 79 74 56 53 61 56 50

Supplementary classifications .............................. V01–V82 4,243 4,168 4,078 4,230 4,309 4,250 4,176

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V27 3,762 3,854 3,781 3,937 4,025 3,973 3,910

1The first-listed diagnoses for females with deliveries is coded V27, shown under ‘‘Supplementary classifications.’’

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

36
Table 16. Rate of female discharges from short-stay hospitals by first-listed diagnosis: United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Diagnostic grouping and code numbers are based on the International Classification of

Diseases, 9th Revision, Clinical Modifications (ICD–9–CM)]

First-listed diagnosis and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Rate of female discharges per 10,000 population

All conditions .............................................. 1,944.0 1,712.2 1,477.4 1,453.2 1,450.2 1,443.3 1,422.0

Infectious and parasitic diseases ............................ 001–139 29.1 29.6 28.7 28.8 29.8 30.7 31.0

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 038 2.7 6.9 8.6 7.9 9.1 10.6 11.4

Neoplasms ......................................... 140–239 124.1 115.0 99.6 91.7 90.9 88.4 88.5

Malignant neoplasms ............................ 140–208,230–234 85.2 83.5 71.7 66.3 65.9 63.0 62.3

Malignant neoplasm of large intestine and rectum ........... 153–154,197.5 9.3 8.5 7.0 6.6 7.1 6.4 6.4

Malignant neoplasm of trachea, bronchus, and lung ......... 162,197.0,197.3 7.2 9.0 8.0 7.3 7.1 6.9 7.0

Malignant neoplasm of breast ....................... 174–175,198.81 18.2 16.9 14.1 12.8 12.8 12.1 13.0

Benign neoplasms and neoplasms of uncertain behavior and unspecified

nature .................................... 210–229,235–239 38.9 31.5 27.9 25.3 25.0 25.5 26.3

Endocrine, nutritional and metabolic diseases, and immunity disorders .... 240–279 64.2 54.0 49.8 50.9 51.2 54.7 53.0

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 34.3 23.4 19.6 19.0 18.0 19.0 20.6

Volume depletion ...................................... 276.5 5.6 12.0 13.0 12.6 15.0 16.1 14.2

Diseases of the blood and blood-forming organs .................. 280–289 16.3 15.8 12.4 13.0 13.0 14.1 14.2

Mental disorders ...................................... 290–319 69.2 64.1 63.3 58.2 59.6 63.4 64.7

Psychoses ........................................ 290–299 22.2 30.8 35.1 33.4 35.4 37.7 38.3

Alcohol dependence syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 8.3 6.2 4.6 4.2 4.3 4.3 4.8

Diseases of the nervous system and sense organs ................ 320–389 83.0 55.2 39.3 36.0 32.5 31.3 29.0

Diseases of the central nervous system ................. 320–336,340–349 18.3 18.7 14.3 14.4 14.6 13.3 12.8

Diseases of the ear and mastoid process ..................... 380–389 17.2 11.6 8.1 7.1 6.3 5.6 5.6

Diseases of the circulatory system .......................... 390–459 218.5 220.1 205.5 199.9 195.3 202.3 209.4

Heart disease .............. 391–392.0,393–398,402,404,410–416,420–429 129.6 137.1 134.6 129.9 128.7 133.9 142.0

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 13.6 23.7 21.2 21.7 20.5 21.3 22.1

Coronary atherosclerosis ................................ 414.0 22.2 9.3 10.7 9.9 10.4 9.3 10.0

Other ischemic heart disease . . . . . . . . . . . . . . . . . . . 411–413,414.1–414.9 27.3 36.3 34.4 33.4 31.8 32.1 35.8

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 17.5 21.8 21.0 21.1 18.7 22.3 21.9

Congestive heart failure ................................ 428.0 19.2 25.4 28.5 26.8 30.2 31.4 34.4

Cerebrovascular disease ............................... 430–438 36.5 41.0 35.8 35.7 35.5 36.1 34.8

Diseases of the respiratory system .......................... 460–519 144.9 134.9 117.6 117.9 120.3 119.7 114.0

Acute respiratory infections .............................. 460–466 23.3 18.7 17.7 18.2 19.8 20.2 14.5

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . 474 22.7 13.4 8.7 6.0 4.8 3.4 3.2

Pneumonia ........................................ 480–486 31.5 34.5 36.1 38.7 40.9 42.1 40.1

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 19.5 21.8 21.5 21.5 22.3 20.9 20.1

Diseases of the digestive system ........................... 520–579 212.4 166.7 140.0 141.9 140.2 139.6 137.7

Ulcers of the stomach and small intestine ..................... 531–534 14.7 11.2 9.5 9.7 8.9 8.7 8.9

Appendicitis ....................................... 540–543 10.4 8.8 8.1 7.3 7.9 8.0 7.1

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 4.4 3.4 2.0 1.6 1.4 1.1 1.1

Noninfectious enteritis and colitis .......................... 555–558 31.4 22.7 18.4 18.0 17.4 16.2 16.8

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 29.3 27.3 28.1 27.7 29.3 30.4 27.5

Diseases of the genitourinary system ......................... 580–629 214.2 151.4 109.9 106.0 107.6 100.0 98.8

Calculus of kidney and ureter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 8.5 9.0 8.3 7.7 7.5 6.3 5.8

Complications of pregnancy, childbirth, and the puerperium1 ........... 630–676 86.5 79.3 66.8 59.8 57.5 56.0 50.8

Abortions and ectopic and molar pregnancies .................. 630–639 45.5 31.3 21.2 18.1 16.3 13.9 13.7

Diseases of the skin and subcutaneous tissue ................... 680–709 26.5 22.4 18.0 19.2 17.8 16.8 17.8

Cellulitis and abscess ................................. 681–682 7.9 9.4 10.8 12.2 10.7 10.2 11.4

Diseases of the musculoskeletal system and connective tissue ......... 710–739 109.1 100.9 69.6 65.3 67.1 66.8 68.7

Arthropathies and related disorders ......................... 710–719 28.1 22.6 21.3 18.8 22.2 23.1 26.3

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 14.8 18.6 13.6 14.0 14.4 12.9 14.2

Congenital anomalies ................................... 740–759 15.1 9.3 7.9 7.5 6.0 7.1 6.8

Certain conditions originating in the perinatal period ................ 760–779 3.3 6.3 5.3 5.0 5.5 5.3 4.6

Symptoms, signs, and ill-defined conditions ..................... 780–799 29.6 22.5 15.8 15.0 16.4 14.3 13.6

Injury and poisoning ................................... 800–999 134.4 123.2 102.3 102.3 101.7 103.2 99.4

Fractures, all sites ................................... 800–829 49.7 47.4 40.6 42.8 43.2 42.9 42.3

Fracture of neck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820 13.6 16.1 14.9 16.1 16.4 17.0 15.7

Intracranial injuries (excluding those with skull fracture) ............ 850–854 9.9 8.7 6.2 5.7 5.6 5.7 4.3

Lacerations and open wounds ............................ 870–904 6.8 6.1 4.5 4.2 4.8 4.4 3.8

Supplementary classifications .............................. V01–V82 363.5 341.6 325.6 334.7 337.6 329.4 320.2

Females with deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V27 322.4 315.8 301.9 311.5 315.4 307.9 299.8

1The first-listed diagnoses for females with deliveries is coded V27, shown under ‘‘Supplementary classifications.’’

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

37
Table 17. Number of discharges from short-stay hospitals with and without procedures and percent with procedures: United States,

1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants]

Year

All

discharges

Discharges

without

procedures

Discharges with procedures1

Total

With surgical

procedures Total

With surgical

procedures

Number in thousands Percent

1980 ................................ 37,832 18,065 19,766 17,005 52.2 44.9

19852 ............................... 35,056 14,406 20,651 16,097 58.9 45.9

1988 ................................ 31,146 11,216 19,930 15,269 64.0 49.0

19892 ............................... 30,947 10,840 20,106 14,690 65.0 47.5

1990 ................................ 30,788 10,562 20,226 14,563 65.7 47.3

19912 ............................... 31,098 10,121 20,977 14,628 67.5 47.0

1992 ................................ 30,951 10,525 20,426 14,483 66.0 46.8

1Procedures are classified for the National Hospital Discharge Survey as surgical or nonsurgical. This classification was revised in 1989. See appendix II for further information.

2Includes procedures not coded in previous years. See appendix II.

38
Table 18. Number of all-listed procedures for discharges from short-stay hospitals by procedure category: United States, 1980, 1985, and

1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Groupings of procedures and code numbers are based on the International

Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Procedure category and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Number of all-listed procedures in thousands

All procedures .................................................. 31,412 36,760 39,192 40,043 40,506 43,922 42,627

Operations on the nervous system ................................. 01–05 728 898 896 909 952 970 921

Spinal tap ............................................... 03.31 216 305 353 377 396 380 339

Operations on the endocrine system ................................ 06–07 117 95 111 113 96 103 102

Operations on the eye ......................................... 08–16 1,050 718 547 448 350 399 332

Operations on the ear ......................................... 18–20 415 256 198 168 137 129 121

Operations on the nose, mouth, and pharynx ........................... 21–29 1,603 1,173 820 734 585 541 533

Tonsillectomy with or without adenoidectomy ....................... 28.2–28.3 464 317 213 155 117 86 80

Operations on the respiratory system ................................ 30–34 868 981 991 1,051 975 956 1,031

Bronchoscopy with or without biopsy1 ...................... 33.21–33.24,33.27 269 292 313 318 298 309 315

Operations on the cardiovascular system ............................. 35–39 1,352 2,414 3,626 3,722 3,881 4,123 4,424

Removal of coronary artery obstruction .............................. 36.0 *6 82 227 259 285 331 399

Coronary artery bypass graft2 .................................... 36.1 137 230 353 368 392 407 468

Cardiac catheterization ................................... 37.21–37.23 348 681 930 958 995 1,000 1,028

Insertion, replacement, removal, and revision of pacemaker leads or device .... 37.7–37.8 187 223 291 275 259 300 274

Shunt or vascular bypass ................................... 39.0–39.2 98 140 140 167 162 168 178

Hemodialysis ............................................. 39.95 38 125 188 192 216 261 322

Operations on the hemic and lymphatic system ......................... 40–41 321 397 392 385 361 392 398

Operations on the digestive system ................................. 42–54 5,320 5,740 5,257 5,360 5,271 5,559 5,358

Endoscopy of small intestine with or without biopsy .............. 45.11–45.14,45.16 282 537 595 752 785 804 864

Endoscopy of large intestine with or without biopsy .................. 45.21–45.25 535 614 537 545 548 574 573

Partial excision of large intestine .................................. 45.7 139 182 202 197 204 220 217

Appendectomy, excluding incidental ................................ 47.0 291 283 273 253 274 255 261

Cholecystectomy ............................................ 51.2 458 475 497 504 522 571 525

Repair of inguinal hernia ................................... 53.0–53.1 537 416 290 243 205 172 139

Lysis of peritoneal adhesions .................................... 54.5 228 309 296 329 323 339 344

Operations on the urinary system .................................. 55–59 1,921 1,729 1,706 1,594 1,664 1,558 1,413

Cystoscopy with or without biopsy ............................ 57.31–57.33 875 666 581 525 527 458 414

Operations on the male genital organs ............................... 60–64 799 744 633 648 594 584 539

Prostatectomy .......................................... 60.2–60.6 335 367 358 376 364 363 353

Operations on the female genital organs .............................. 65–71 4,274 3,318 2,501 2,385 2,440 2,308 2,302

Oophorectomy and salpingo-oophorectomy ........................ 65.3–65.6 483 525 451 421 476 458 464

Bilateral destruction or occlusion of fallopian tubes ................... 66.2–66.3 641 466 406 389 419 401 380

Hysterectomy .......................................... 68.3–68.7 649 670 578 541 591 546 580

Dilation and curettage of uterus ................................... 69.0 1,251 597 279 265 220 196 173

Repair of cystocele and rectocele .................................. 70.5 162 165 136 135 137 139 141

Obstetrical procedures ......................................... 72–75 3,603 4,304 6,042 6,383 6,792 6,867 6,664

Episiotomy with or without forceps or vacuum extraction ......72.1,72.21,72.31,72.71,73.6 2,014 1,820 1,680 1,704 1,717 1,684 1,611

Artificial rupture of membranes ................................... 73.0 120 316 586 654 691 775 729

Cesarean section ................................. 74.0–74.2,74.4,74.99 619 877 933 938 945 933 921

Fetal EKG (scalp) and fetal monitoring, not otherwise specified .......... 75.32,75.34 124 275 1,143 1,206 1,377 1,327 1,241

Repair of current obstetric laceration ............................ 75.5–75.6 355 548 690 762 795 795 790

Operations on the musculoskeletal system ............................ 76–84 3,215 3,523 3,143 3,171 3,132 3,323 3,266

Partial excision of bone .............................. 76.2–76.3,77.6–77.8 205 225 190 215 193 216 222

Open reduction of fracture with internal fixation ......................... 79.3 301 393 394 409 391 418 417

Excision or destruction of intervertebral disc ........................... 80.5 142 228 250 262 305 306 319

Total hip replacement3 ........................................ 81.51 58 111 129 - - - 119 117 127

Total knee replacement .................................... 81.41,81.54 45 73 105 94 129 160 167

Operations on the integumentary system .............................. 85–86 1,896 1,653 1,475 1,428 1,387 1,324 1,371

Mastectomy ............................................... 85.4 109 116 124 120 122 118 117

Debridement of wound, infection, or burn ........................ 86.22,86.28 196 265 322 351 332 326 308

Skin graft ............................................. 86.6–86.7 183 157 148 124 110 99 108

Miscellaneous diagnostic and therapeutic procedures ...................... 87–99 3,930 8,819 10,854 11,544 11,890 14,785 13,854

Computerized axial tomography ................... 87.03,87.41,87.71,88.01,88.38 306 1,378 1,613 1,519 1,506 1,459 1,266

Pyelogram ........................................... 87.73–87.75 466 443 325 288 291 245 203

Arteriography and angiocardiography using contrast material ............. 88.4–88.5 569 1,117 1,624 1,620 1,735 1,718 1,771

Diagnostic ultrasound ......................................... 88.7 318 1,234 1,562 1,558 1,608 1,592 1,458

Circulatory monitoring ......................................... 89.6 76 635 846 779 724 703 596

Radioisotope scan ....................................... 92.0–92.1 525 838 704 635 603 539 464

Respiratory therapy ....................................... 93.9,96.7 *7 62 272 927 1,164 1,214 1,195

- - - Data not available.

*Figure does not meet standard of reliability or precision.

1ICD–9–CM code 33.27 was not included in the category before 1987.

2Number of coronary artery bypass graft procedures. See table 31 for number of discharges with coronary artery bypass grafts.

3Total hip replacement was not available in 1989 due to a change in codes. Before 1989, the ICD–9–CM code was 81.5.

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for additional information about changes in coding system and coding modifications for the National Hospital Discharge Survey. 39
Table 19. Rate of all-listed procedures for discharges from short-stay hospitals by procedure category: United States, 1980, 1985, and

1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Groupings of procedures and code numbers are based on the International

Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Procedure category and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Rate of all-listed procedures per 100,000 population

All procedures .................................................. 13,922.3 15,561.8 16,140.4 16,335.2 16,349.3 17,529.3 16,815.7

Operations on the nervous system ................................. 01–05 322.6 380.1 369.0 370.9 384.1 387.3 363.2

Spinal tap ............................................... 03.31 95.9 129.1 145.6 154.0 159.8 151.6 133.7

Operations on the endocrine system ................................ 06–07 51.9 40.2 45.6 46.2 38.6 41.0 40.0

Operations on the eye ......................................... 08–16 465.3 304.1 225.2 182.7 141.1 159.2 130.9

Operations on the ear ......................................... 18–20 183.9 108.5 81.3 68.6 55.1 51.6 47.7

Operations on the nose, mouth, and pharynx ........................... 21–29 710.5 496.6 337.9 299.5 236.2 216.1 210.1

Tonsillectomy with or without adenoidectomy ....................... 28.2–28.3 205.6 134.4 87.8 63.2 47.4 34.1 31.4

Operations on the respiratory system ................................ 30–34 384.5 415.1 408.2 428.7 393.6 381.7 406.7

Bronchoscopy with or without biopsy1 ...................... 33.21–33.24,33.27 119.2 123.6 128.7 129.9 120.3 123.4 124.4

Operations on the cardiovascular system ............................. 35–39 599.4 1,021.8 1,493.2 1,518.2 1,566.4 1,645.5 1,745.1

Removal of coronary artery obstruction .............................. 36.0 *2.6 34.7 93.3 105.6 115.2 131.9 157.2

Coronary artery bypass graft2 .................................... 36.1 60.8 97.5 145.4 150.2 158.3 162.6 184.8

Cardiac catheterization ................................... 37.21–37.23 154.4 288.1 382.9 390.7 401.8 399.1 405.6

Insertion, replacement, removal, and revision of pacemaker leads or device . . . 37.7–37.8 83.0 94.6 119.8 112.1 104.5 119.6 108.1

Shunt or vascular bypass ................................... 39.0–39.2 43.6 59.1 57.7 68.3 65.2 67.2 70.3

Hemodialysis ............................................. 39.95 17.0 52.8 77.4 78.4 87.3 104.0 127.2

Operations on the hemic and lymphatic system ......................... 40–41 142.5 168.0 161.6 157.0 145.7 156.3 156.8

Operations on the digestive system ................................. 42–54 2,357.9 2,430.1 2,165.1 2,186.6 2,127.5 2,218.8 2,113.6

Endoscopy of small intestine with or without biopsy .............. 45.11–45.14,45.16 124.8 227.4 244.9 306.6 316.8 320.9 341.0

Endoscopy of large intestine with or without biopsy .................. 45.21–45.25 237.2 260.1 221.1 222.2 221.2 229.0 226.0

Partial excision of large intestine .................................. 45.7 61.5 77.0 83.2 80.2 82.5 87.7 85.6

Appendectomy, excluding incidental ................................ 47.0 128.8 119.9 112.4 103.1 110.5 101.8 102.9

Cholecystectomy ............................................ 51.2 203.0 201.0 204.7 205.4 210.7 227.8 207.1

Repair of inguinal hernia ................................... 53.0–53.1 238.1 176.0 119.3 99.2 82.7 68.8 54.9

Lysis of peritoneal adhesions .................................... 54.5 101.2 130.7 121.8 134.2 130.5 135.4 135.5

Operations on the urinary system .................................. 55–59 851.5 731.7 702.5 650.4 671.7 621.8 557.4

Cystoscopy with or without biopsy ............................ 57.31–57.33 387.9 282.0 239.5 214.1 212.8 182.6 163.5

Operations on the male genital organs ............................... 60–64 354.0 314.8 260.6 264.3 239.8 233.2 212.5

Prostatectomy .......................................... 60.2–60.6 148.5 155.3 147.2 153.5 146.8 145.1 139.1

Operations on the female genital organs .............................. 65–71 1,894.3 1,404.4 1,030.1 973.1 984.8 921.3 908.2

Oophorectomy and salpingo-oophorectomy ........................ 65.3–65.6 214.1 222.1 185.7 171.6 192.1 182.7 183.1

Bilateral destruction or occlusion of fallopian tubes ................... 66.2–66.3 284.0 197.5 167.2 158.5 169.0 160.1 149.8

Hysterectomy .......................................... 68.3–68.7 287.8 283.8 238.2 220.6 238.6 218.0 228.8

Dilation and curettage of uterus ................................... 69.0 554.5 252.9 115.0 107.9 88.9 78.0 68.3

Repair of cystocele and rectocele .................................. 70.5 71.7 69.7 56.0 55.1 55.2 55.3 55.7

Obstetrical procedures ......................................... 72–75 1,597.0 1,821.9 2,488.2 2,603.8 2,741.6 2,740.4 2,628.9

Episiotomy with or without forceps or vacuum extraction ..... 72.1,72.21,72.31,72.71,73.6 892.5 770.6 692.1 695.0 693.1 672.2 635.4

Artificial rupture of membranes ................................... 73.0 53.2 133.8 241.4 266.7 278.9 309.2 287.5

Cesarean section ................................. 74.0–74.2,74.4,74.99 274.6 371.2 384.4 382.6 381.6 372.5 363.3

Fetal EKG (scalp) and fetal monitoring, not otherwise specified .......... 75.32,75.34 55.1 116.2 470.7 492.0 555.7 529.5 489.6

Repair of current obstetric laceration ............................ 75.5–75.6 157.2 231.8 284.3 310.9 320.8 317.3 311.8

Operations on the musculoskeletal system ............................ 76–84 1,425.0 1,491.4 1,294.5 1,293.5 1,264.3 1,326.4 1,288.3

Partial excision of bone .............................. 76.2–76.3,77.6–77.8 91.1 95.1 78.1 87.8 77.9 86.2 87.6

Open reduction of fracture with internal fixation ......................... 79.3 133.6 166.4 162.2 166.9 157.8 166.7 164.4

Excision or destruction of intervertebral disc ........................... 80.5 63.2 96.4 103.0 107.1 123.0 122.2 125.9

Total hip replacement3 ........................................ 81.51 25.7 46.8 53.1 - - - 48.0 46.6 50.1

Total knee replacement ................................... 81.41,81.54 20.2 30.9 43.4 38.3 52.1 64.0 66.1

Operations on the integumentary system .............................. 85–86 840.2 699.6 607.3 582.4 559.8 528.5 540.9

Mastectomy ............................................... 85.4 48.2 49.1 51.0 49.1 49.2 47.2 46.0

Debridement of wound, infection, or burn ........................ 86.22,86.28 86.9 112.1 132.7 143.0 134.1 130.0 121.4

Skin graft ............................................. 86.6–86.7 81.1 66.3 60.8 50.7 44.4 39.5 42.5

Miscellaneous diagnostic and therapeutic procedures ...................... 87–99 1,741.8 3,733.4 4,470.2 4,709.3 4,799.1 5,900.5 5,465.1

Computerized axial tomography ................... 87.03,87.41,87.71,88.01,88.38 135.6 583.2 664.1 619.5 607.8 582.4 499.4

Pyelogram ........................................... 87.73–87.75 206.7 187.3 133.9 117.3 117.5 97.8 79.9

Arteriography and angiocardiography using contrast material ............. 88.4–88.5 252.3 472.9 668.7 661.0 700.4 685.8 698.7

Diagnostic ultrasound ......................................... 88.7 141.2 522.3 643.2 635.7 649.2 635.2 575.2

Circulatory monitoring ......................................... 89.6 33.7 268.8 348.2 318.0 292.4 280.5 234.9

Radioisotope scan ....................................... 92.0–92.1 232.6 354.8 290.0 259.0 243.4 215.0 183.1

Respiratory therapy ....................................... 93.9,96.7 *3.3 26.1 112.0 378.2 469.8 484.5 471.4

- - - Data not available. *Figure does not meet standard of reliability or precision.

1ICD–9–CM code 33.27 was not included in the category before 1987.

2Rate of coronary artery bypass graft procedures. See table 31 for rate of discharges with coronary artery bypass grafts.

3Total hip replacement was not available in 1989 due to a change in codes. Before 1989, the ICD–9–CM code was 81.5.

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for additional information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

40
Table 20. Number of all-listed procedures for male discharges from short-stay hospitals by procedure category: United States, 1980,

1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Groupings of procedures and code numbers are based on the International

Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Procedure category and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Number of all-listed procedures for males in thousands

All procedures .................................................. 11,891 14,694 15,735 16,088 15,916 17,264 16,791

Operations on the nervous system ................................. 01–05 362 451 467 475 479 500 442

Spinal tap ............................................... 03.31 107 159 183 203 204 208 184

Operations on the endocrine system ................................ 06–07 32 24 31 31 26 28 29

Operations on the eye ......................................... 08–16 451 309 243 198 174 189 162

Operations on the ear ......................................... 18–20 218 130 109 93 73 75 68

Operations on the nose, mouth, and pharynx ........................... 21–29 779 589 436 386 327 288 280

Tonsillectomy with or without adenoidectomy ....................... 28.2–28.3 195 135 94 69 49 40 33

Operations on the respiratory system ................................ 30–34 538 582 561 608 555 561 575

Bronchoscopy with or without biopsy1 ...................... 33.21–33.24,33.27 167 181 182 192 175 186 178

Operations on the cardiovascular system ............................. 35–39 821 1,425 2,220 2,236 2,317 2,383 2,630

Removal of coronary artery obstruction .............................. 36.0 *5 58 160 177 200 223 262

Coronary artery bypass graft2 .................................... 36.1 108 172 270 271 286 296 347

Cardiac catheterization ................................... 37.21–37.23 228 439 598 601 620 603 636

Insertion, replacement, removal, and revision of pacemaker leads or device . . . 37.7–37.8 102 118 165 142 138 145 140

Shunt or vascular bypass ................................... 39.0–39.2 60 79 85 97 95 92 99

Hemodialysis ............................................. 39.95 20 62 99 105 105 129 156

Operations on the hemic and lymphatic system ......................... 40–41 156 190 192 190 187 212 202

Operations on the digestive system ................................. 42–54 2,334 2,530 2,277 2,309 2,194 2,319 2,258

Endoscopy of small intestine with or without biopsy .............. 45.11–45.14,45.16 117 250 274 348 357 391 405

Endoscopy of large intestine with or without biopsy .................. 45.21–45.25 228 269 230 218 212 234 238

Partial excision of large intestine .................................. 45.7 58 80 86 88 89 94 91

Appendectomy, excluding incidental ................................ 47.0 146 150 147 141 147 135 143

Cholecystectomy ............................................ 51.2 122 147 132 144 147 166 165

Repair of inguinal hernia ................................... 53.0–53.1 483 370 261 220 181 155 121

Lysis of peritoneal adhesions .................................... 54.5 32 44 51 59 62 60 67

Operations on the urinary system .................................. 55–59 1,087 1,049 1,018 962 946 884 776

Cystoscopy with or without biopsy ............................ 57.31–57.33 548 472 424 379 377 333 291

Operations on the male genital organs ............................... 60–64 799 744 633 648 594 584 539

Prostatectomy .......................................... 60.2–60.6 335 367 358 376 364 363 353

Operations on the musculoskeletal system ............................ 76–84 1,666 1,734 1,648 1,676 1,624 1,710 1,652

Partial excision of bone .............................. 76.2–76.3,77.6–77.8 91 112 102 120 112 119 115

Open reduction of fracture with internal fixation ......................... 79.3 153 178 193 186 177 193 187

Excision or destruction of intervertebral disc ........................... 80.5 85 136 158 157 175 181 175

Total hip replacement3 ........................................ 81.51 21 41 47 - - - 48 50 49

Total knee replacement .................................... 81.41,81.54 13 28 34 30 46 60 53

Operations on the integumentary system .............................. 85–86 754 658 639 633 580 552 563

Mastectomy ............................................... 85.4 *6 ******

Debridement of wound, infection, or burn ........................ 86.22,86.28 130 152 196 218 184 181 178

Skin graft ............................................. 86.6–86.7 106 96 91 75 66 60 59

Miscellaneous diagnostic and therapeutic procedures ...................... 87–99 1,894 4,279 5,262 5,644 5,842 6,981 6,615

Computerized axial tomography ................... 87.03,87.41,87.71,88.01,88.38 152 671 775 721 736 702 608

Pyelogram ........................................... 87.73–87.75 241 243 192 161 149 133 105

Arteriography and angiocardiography using contrast material ............. 88.4–88.5 355 693 995 1,000 1,051 989 1,060

Diagnostic ultrasound ......................................... 88.7 114 478 599 628 667 652 587

Circulatory monitoring ......................................... 89.6 39 332 430 388 344 339 287

Radioisotope scan ....................................... 92.0–92.1 236 375 315 287 268 228 203

Respiratory therapy ....................................... 93.9,96.7 * 34 148 472 586 596 579

* Figure does not meet standard of reliability or precision.

- - - Data not available.

1ICD–9–CM code 33.27 was not included in the category before 1987.

2Number of coronary artery bypass graft procedures. See table 31 for number of discharges with coronary artery bypass grafts.

3Total hip replacement was not available in 1989 due to a change in codes. Before 1989, the ICD–9–CM code was 81.5.

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for additional information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

41
Table 21. Rate of all-listed procedures for male discharges from short-stay hospitals by procedure category: United States, 1980, 1985,

and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Groupings of procedures and code numbers are based on the International

Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Procedure category and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Rate of all-listed procedures per 100,000 male population

All procedures .................................................. 10,916.7 12,868.6 13,383.1 13,546.6 13,249.7 14,204.6 13,642.3

Operations on the nervous system ................................. 01–05 332.4 395.0 397.6 399.7 399.1 411.5 359.1

Spinal tap ............................................... 03.31 98.2 139.0 155.4 171.3 170.0 171.1 149.4

Operations on the endocrine system ................................ 06–07 29.0 20.7 26.7 25.8 21.4 22.9 23.6

Operations on the eye ......................................... 08–16 414.1 270.5 206.5 166.6 144.6 155.7 131.9

Operations on the ear ......................................... 18–20 200.6 114.3 92.8 78.5 60.5 61.7 54.9

Operations on the nose, mouth, and pharynx ........................... 21–29 715.2 515.5 370.4 325.3 272.1 236.7 227.7

Tonsillectomy with or without adenoidectomy ....................... 28.2–28.3 179.3 117.9 79.7 57.9 41.1 32.5 26.9

Operations on the respiratory system ................................ 30–34 493.8 510.0 477.2 512.3 461.8 461.2 467.0

Bronchoscopy with or without biopsy1 ...................... 33.21–33.24,33.27 153.0 158.8 154.7 161.4 145.8 153.4 144.4

Operations on the cardiovascular system ............................. 35–39 753.7 1,248.1 1,888.2 1,882.7 1,928.5 1,960.3 2,136.9

Removal of coronary artery obstruction .............................. 36.0 *4.6 50.4 136.1 149.1 166.8 183.5 213.3

Coronary artery bypass graft2 .................................... 36.1 99.1 151.1 229.3 228.1 238.3 243.5 281.8

Cardiac catheterization ................................... 37.21–37.23 209.6 384.6 508.4 506.1 515.8 496.0 517.1

Insertion, replacement, removal, and revision of pacemaker leads or device . . . 37.7–37.8 94.1 103.4 140.7 119.7 114.8 119.3 113.5

Shunt or vascular bypass ................................... 39.0–39.2 54.9 69.3 72.6 81.5 78.9 75.7 80.8

Hemodialysis ............................................. 39.95 18.0 54.0 83.9 88.6 87.6 106.0 126.5

Operations on the hemic and lymphatic system ......................... 40–41 143.3 166.1 163.6 160.2 155.3 174.3 164.4

Operations on the digestive system ................................. 42–54 2,142.8 2,215.6 1,936.3 1,944.0 1,826.5 1,908.0 1,834.4

Endoscopy of small intestine with or without biopsy .............. 45.11–45.14,45.16 107.7 218.7 232.9 293.0 297.2 321.9 329.1

Endoscopy of large intestine with or without biopsy .................. 45.21–45.25 209.6 236.0 195.7 183.7 176.4 192.6 193.5

Partial excision of large intestine .................................. 45.7 53.3 69.7 73.5 74.3 73.9 77.7 74.0

Appendectomy, excluding incidental ................................ 47.0 134.1 131.4 124.7 118.5 122.5 111.4 116.1

Cholecystectomy ............................................ 51.2 112.4 129.1 112.0 121.5 122.7 136.9 133.9

Repair of inguinal hernia ................................... 53.0–53.1 443.8 323.8 221.7 184.9 150.6 127.4 98.2

Lysis of peritoneal adhesions .................................... 54.5 29.3 38.6 43.3 49.9 51.5 49.4 54.4

Operations on the urinary system .................................. 55–59 998.1 918.9 865.8 809.6 787.5 727.4 630.5

Cystoscopy with or without biopsy ............................ 57.31–57.33 503.4 413.0 360.4 319.2 314.0 273.9 236.5

Operations on the male genital organs ............................... 60–64 733.4 651.2 538.1 545.6 494.5 480.8 437.8

Prostatectomy .......................................... 60.2–60.6 307.5 321.2 304.1 316.9 302.8 299.1 286.6

Operations on the musculoskeletal system ............................ 76–84 1,529.7 1,518.2 1,401.5 1,411.3 1,351.8 1,406.7 1,342.3

Partial excision of bone .............................. 76.2–76.3,77.6–77.8 84.0 98.3 86.7 101.3 93.3 97.6 93.7

Open reduction of fracture with internal fixation ......................... 79.3 140.2 156.1 164.2 156.7 147.0 158.4 151.9

Excision or destruction of intervertebral disc ........................... 80.5 78.2 119.3 134.4 131.9 145.7 149.3 142.4

Total hip replacement3 ........................................ 81.51 19.6 36.2 40.0 - - - 40.1 41.1 39.4

Total knee replacement ................................... 81.41,81.54 12.1 24.2 29.1 25.5 37.9 49.4 42.9

Operations on the integumentary system .............................. 85–86 691.8 576.6 543.2 533.1 482.5 453.8 457.7

Mastectomy ............................................... 85.4 *5.4 ******

Debridement of wound, infection, or burn ........................ 86.22,86.28 119.0 133.5 166.7 183.9 153.0 149.0 145.0

Skin graft ............................................. 86.6–86.7 97.1 84.4 77.7 63.1 54.9 49.0 48.1

Miscellaneous diagnostic and therapeutic procedures ...................... 87–99 1,738.8 3,747.9 4,475.3 4,751.9 4,863.5 5,743.6 5,374.2

Computerized axial tomography ................... 87.03,87.41,87.71,88.01,88.38 139.1 587.5 659.2 607.2 612.3 577.4 493.9

Pyelogram ........................................... 87.73–87.75 221.6 212.5 163.1 135.1 123.9 109.3 85.0

Arteriography and angiocardiography using contrast material ............. 88.4–88.5 325.6 606.5 846.2 841.9 874.6 813.8 861.3

Diagnostic ultrasound ......................................... 88.7 104.8 418.4 509.3 528.8 555.3 536.2 477.2

Circulatory monitoring ......................................... 89.6 35.6 290.8 365.9 327.0 286.7 278.9 232.9

Radioisotope scan ....................................... 92.0–92.1 216.5 328.1 267.6 242.0 223.1 187.5 165.3

Respiratory therapy ....................................... 93.9,96.7 * 30.1 126.0 397.2 487.6 490.1 470.3

- - - Data not available.

* Figure does not meet standard of reliability or precision.

1ICD–9–CM code 33.27 was not included in the category before 1987.

2Rate of coronary artery bypass graft procedures. See table 31 for rate of discharges with coronary artery bypass grafts.

3Total hip replacement was not available in 1989 due to a change in codes. Before 1989, the ICD–9–CM code was 81.5.

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for additional information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

42
Table 22. Number of all-listed procedures for female discharges from short-stay hospitals by procedure category: United States, 1980,

1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Groupings of procedures and code numbers are based on the International

Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Procedure category and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Number of all-listed procedures for females in thousands

All procedures .................................................. 19,521 22,066 23,457 23,954 24,590 26,658 25,836

Operations on the nervous system ................................. 01–05 366 447 429 435 472 470 479

Spinal tap ............................................... 03.31 110 146 171 174 192 172 155

Operations on the endocrine system ................................ 06–07 85 71 79 83 70 75 72

Operations on the eye ......................................... 08–16 599 409 304 250 176 210 169

Operations on the ear ......................................... 18–20 197 126 88 75 64 54 53

Operations on the nose, mouth, and pharynx ........................... 21–29 824 584 385 348 258 254 252

Tonsillectomy with or without adenoidectomy ....................... 28.2–28.3 269 183 119 86 68 46 46

Operations on the respiratory system ................................ 30–34 330 398 430 442 420 396 456

Bronchoscopy with or without biopsy1 ...................... 33.21–33.24,33.27 102 111 131 127 123 123 138

Operations on the cardiovascular system ............................. 35–39 531 989 1,406 1,486 1,564 1,740 1,794

Removal of coronary artery obstruction .............................. 36.0 * 24 67 82 85 107 136

Coronary artery bypass graft2 .................................... 36.1 29 58 83 97 106 111 122

Cardiac catheterization ................................... 37.21–37.23 120 241 332 357 376 397 392

Insertion, replacement, removal, and revision of pacemaker leads or device . . . 37.7–37.8 85 105 125 133 121 155 134

Shunt or vascular bypass ................................... 39.0–39.2 39 61 55 71 67 76 79

Hemodialysis ............................................. 39.95 19 63 89 87 111 132 167

Operations on the hemic and lymphatic system ......................... 40–41 165 207 200 195 174 180 195

Operations on the digestive system ................................. 42–54 2,986 3,210 2,981 3,051 3,077 3,241 3,100

Endoscopy of small intestine with or without biopsy .............. 45.11–45.14,45.16 164 287 321 404 428 413 459

Endoscopy of large intestine with or without biopsy .................. 45.21–45.25 307 345 307 326 336 340 335

Partial excision of large intestine .................................. 45.7 81 102 116 108 116 125 126

Appendectomy, excluding incidental ................................ 47.0 145 133 126 112 127 120 118

Cholecystectomy ............................................ 51.2 336 327 365 359 375 404 360

Repair of inguinal hernia ................................... 53.0–53.1 54 46 29 24 24 17 18

Lysis of peritoneal adhesions .................................... 54.5 197 265 245 270 261 279 277

Operations on the urinary system .................................. 55–59 834 679 688 633 718 674 637

Cystoscopy with or without biopsy ............................ 57.31–57.33 327 195 158 146 150 125 123

Operations on the female genital organs .............................. 65–71 4,274 3,318 2,501 2,385 2,440 2,308 2,302

Oophorectomy and salpingo-oophorectomy ........................ 65.3–65.6 483 525 451 421 476 458 464

Bilateral destruction or occlusion of fallopian tubes ................... 66.2–66.3 641 466 406 389 419 401 380

Hysterectomy .......................................... 68.3–68.7 649 670 578 541 591 546 580

Dilation and curettage of uterus ................................... 69.0 1,251 597 279 265 220 196 173

Repair of cystocele and rectocele .................................. 70.5 162 165 136 135 137 139 141

Obstetrical procedures ......................................... 72–75 3,603 4,304 6,042 6,383 6,792 6,867 6,664

Episiotomy with or without forceps or vacuum extraction ..... 72.1,72.21,72.31,72.71,73.6 2,014 1,820 1,680 1,704 1,717 1,684 1,611

Artificial rupture of membranes ................................... 73.0 120 316 586 654 691 775 729

Cesarean section ................................. 74.0–74.2,74.4,74.99 619 877 933 938 945 933 921

Fetal EKG (scalp) and fetal monitoring, not otherwise specified .......... 75.32,75.34 124 275 1,143 1,206 1,377 1,327 1,241

Repair of current obstetric laceration ............................ 75.5–75.6 355 548 690 762 795 795 790

Operations on the musculoskeletal system ............................ 76–84 1,549 1,789 1,496 1,495 1,508 1,614 1,614

Partial excision of bone .............................. 76.2–76.3,77.6–77.8 114 112 88 95 81 97 107

Open reduction of fracture with internal fixation ......................... 79.3 149 215 201 223 214 225 230

Excision or destruction of intervertebral disc ........................... 80.5 57 92 92 106 130 125 144

Total hip replacement3 ........................................ 81.51 37 69 82 - - - 71 67 79

Total knee replacement ................................... 81.41,81.54 32 45 71 64 83 100 115

Operations on the integumentary system .............................. 85–86 1,142 994 836 795 807 773 808

Mastectomy ............................................... 85.4 103 114 123 118 121 117 116

Debridement of wound, infection, or burn ........................ 86.22,86.28 67 112 126 132 148 145 129

Skin graft ............................................. 86.6–86.7 77 60 56 49 44 39 48

Miscellaneous diagnostic and therapeutic procedures ...................... 87–99 2,036 4,540 5,593 5,900 6,048 7,804 7,239

Computerized axial tomography ................... 87.03,87.41,87.71,88.01,88.38 154 707 838 798 770 757 658

Pyelogram ........................................... 87.73–87.75 225 200 133 127 142 112 98

Arteriography and angiocardiography using contrast material ............. 88.4–88.5 215 425 629 620 685 729 711

Diagnostic ultrasound ......................................... 88.7 204 756 963 930 941 940 871

Circulatory monitoring ......................................... 89.6 37 303 415 391 380 364 309

Radioisotope scan ....................................... 92.0–92.1 289 463 390 347 335 311 261

Respiratory therapy ....................................... 93.9,96.7 * 27 124 455 578 618 616

* Figure does not meet standard of reliability or precision.

- - - Data not available.

1ICD–9–CM code 33.27 was not included in the category before 1987.

2Number of coronary artery bypass graft procedures. See table 31 for number of discharges with coronary artery bypass grafts.

3Total hip replacement was not available in 1989 due to a change in codes. Before 1989, the ICD–9–CM code was 81.5.

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for additional information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

43
Table 23. Rate of all-listed procedures for female discharges from short-stay hospitals by procedure category: United States, 1980, 1985,

and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Groupings of procedures and code numbers are based on the International

Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Procedure category and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Rate of all-listed procedures per 100,000 female population

All procedures ................................................ 16,727.7 18,081.6 18,728.8 18,956.0 19,266.8 20,661.0 19,810.6

Operations on the nervous system .............................. 01–05 313.4 366.2 342.2 343.9 370.0 364.5 367.1

Spinal tap ............................................. 03.31 93.8 119.9 136.3 137.7 150.2 133.2 118.8

Operations on the endocrine system ............................. 06–07 73.2 58.5 63.3 65.4 54.8 58.1 55.6

Operations on the eye ...................................... 08–16 513.0 335.5 242.7 197.8 137.8 162.4 129.9

Operations on the ear ...................................... 18–20 168.4 103.0 70.6 59.2 50.0 42.0 41.0

Operations on the nose, mouth, and pharynx ........................ 21–29 706.1 478.9 307.3 275.3 202.5 196.7 193.6

Tonsillectomy with or without adenoidectomy ..................... 28.2–28.3 230.1 149.8 95.3 68.3 53.2 35.7 35.6

Operations on the respiratory system ............................. 30–34 282.5 326.3 343.4 350.1 329.4 306.6 349.8

Bronchoscopy with or without biopsy1 .................... 33.21–33.24,33.27 87.6 90.7 104.4 100.3 96.2 95.2 105.5

Operations on the cardiovascular system .......................... 35–39 455.4 810.1 1,122.5 1,175.6 1,225.7 1,348.9 1,375.4

Removal of coronary artery obstruction ............................ 36.0 * 19.9 53.1 64.7 66.6 83.3 104.3

Coronary artery bypass graft2 .................................. 36.1 25.1 47.4 66.5 77.0 83.0 86.4 93.2

Cardiac catheterization ................................ 37.21–37.23 102.9 197.8 265.2 282.3 294.5 307.9 300.4

Insertion, replacement, removal, and revision of pacemaker leads or device . 37.7–37.8 72.7 86.3 100.2 105.1 94.8 119.9 102.9

Shunt or vascular bypass ................................. 39.0–39.2 33.1 49.6 43.8 55.9 52.3 59.1 60.4

Hemodialysis ........................................... 39.95 16.0 51.7 71.3 68.8 87.1 102.2 127.8

Operations on the hemic and lymphatic system ...................... 40–41 141.7 169.8 159.6 154.0 136.7 139.4 149.7

Operations on the digestive system .............................. 42–54 2,558.7 2,630.7 2,379.9 2,414.5 2,410.7 2,511.9 2,377.0

Endoscopy of small intestine with or without biopsy ............ 45.11–45.14,45.16 140.7 235.5 256.1 319.4 335.2 320.0 352.1

Endoscopy of large intestine with or without biopsy ............... 45.21–45.25 263.0 282.6 245.0 258.3 263.3 263.4 256.7

Partial excision of large intestine ................................ 45.7 69.1 83.8 92.4 85.8 90.6 97.1 96.6

Appendectomy, excluding incidental .............................. 47.0 123.8 109.1 100.9 88.6 99.2 92.7 90.4

Cholecystectomy .......................................... 51.2 287.6 268.3 291.7 284.3 293.5 313.4 276.1

Repair of inguinal hernia ................................. 53.0–53.1 46.1 37.7 23.3 18.6 18.8 13.6 14.1

Lysis of peritoneal adhesions .................................. 54.5 168.4 217.0 195.5 213.3 204.7 216.5 212.1

Operations on the urinary system ............................... 55–59 714.6 556.7 549.2 500.8 562.7 522.3 488.5

Cystoscopy with or without biopsy ......................... 57.31–57.33 280.1 159.5 126.0 115.3 117.6 96.7 94.6

Operations on the female genital organs ........................... 65–71 3,662.5 2,718.5 1,997.1 1,887.7 1,911.6 1,789.0 1,765.4

Oophorectomy and salpingo-oophorectomy ...................... 65.3–65.6 413.9 429.8 359.9 332.8 373.0 354.8 355.9

Bilateral destruction or occlusion of fallopian tubes ................. 66.2–66.3 549.1 382.3 324.2 307.5 328.1 310.9 291.1

Hysterectomy ........................................ 68.3–68.7 556.5 549.3 461.8 427.8 463.1 423.4 444.7

Dilation and curettage of uterus ................................. 69.0 1,072.1 489.5 223.0 209.4 172.6 151.6 132.8

Repair of cystocele and rectocele ................................ 70.5 138.6 134.8 108.5 106.9 107.2 107.4 108.2

Obstetrical procedures ...................................... 72–75 3,087.6 3,526.6 4,823.9 5,050.9 5,322.1 5,321.8 5,109.9

Episiotomy with or without forceps or vacuum extraction . . . 72.1,72.21,72.31,72.71,73.6 1,725.5 1,491.5 1,341.7 1,348.1 1,345.5 1,305.5 1,235.1

Artificial rupture of membranes ................................. 73.0 102.8 258.9 468.0 517.3 541.4 600.4 558.9

Cesarean section ............................... 74.0–74.2,74.4,74.99 530.9 718.4 745.3 742.2 740.7 723.4 706.1

Fetal EKG (scalp) and fetal monitoring, not otherwise specified ........ 75.32,75.34 106.4 224.9 912.6 954.5 1,078.7 1,028.1 951.6

Repair of current obstetric laceration .......................... 75.5–75.6 304.0 448.7 551.2 603.1 622.6 616.1 606.1

Operations on the musculoskeletal system ......................... 76–84 1,327.3 1,466.2 1,194.2 1,182.8 1,181.9 1,250.6 1,237.4

Partial excision of bone ........................... 76.2–76.3,77.6–77.8 97.7 92.1 70.0 75.1 63.3 75.5 81.7

Open reduction of fracture with internal fixation ....................... 79.3 127.5 176.1 160.3 176.5 167.9 174.6 176.3

Excision or destruction of intervertebral disc ......................... 80.5 49.1 75.1 73.5 83.7 101.6 96.6 110.4

Total hip replacement3 ...................................... 81.51 31.3 56.8 65.3 - - - 55.4 51.8 60.2

Total knee replacement ................................. 81.41,81.54 27.7 37.2 56.8 50.3 65.4 77.8 87.9

Operations on the integumentary system ........................... 85–86 978.6 814.6 667.6 628.8 632.5 598.8 619.4

Mastectomy ............................................. 85.4 88.2 93.7 97.8 93.2 94.7 90.9 88.8

Debridement of wound, infection, or burn ...................... 86.22,86.28 57.1 92.2 100.9 104.6 116.2 112.1 99.1

Skin graft ........................................... 86.6–86.7 66.2 49.4 45.0 39.2 34.5 30.6 37.1

Miscellaneous diagnostic and therapeutic procedures ................... 87–99 1,744.7 3,720.0 4,465.4 4,669.2 4,738.5 6,048.2 5,551.0

Computerized axial tomography ................ 87.03,87.41,87.71,88.01,88.38 132.3 579.2 668.8 631.2 603.5 587.0 504.7

Pyelogram ........................................ 87.73–87.75 192.7 163.8 106.4 100.5 111.5 86.9 75.1

Arteriography and angiocardiography using contrast material ........... 88.4–88.5 183.8 347.9 502.3 490.9 536.4 565.3 545.2

Diagnostic ultrasound ....................................... 88.7 175.1 619.6 768.9 736.1 737.6 728.5 667.6

Circulatory monitoring ....................................... 89.6 31.9 248.3 331.6 309.5 297.7 282.0 236.9

Radioisotope scan ..................................... 92.0–92.1 247.6 379.8 311.0 274.9 262.5 240.7 199.9

Respiratory therapy .................................... 93.9,96.7 * 22.4 98.9 360.4 453.1 479.1 472.6

* Figure does not meet standard of reliability or precision.

- - - Data not available.

1ICD–9–CM code 33.27 was not included in the category before 1987.

2Rate of coronary artery bypass graft procedures. See table 31 for rate of discharges with coronary artery bypass grafts.

3Total hip replacement was not available in 1989 due to a change in codes. Before 1989, the ICD–9–CM code was 81.5.

NOTE: See ‘‘Medical Coding and Edit,’’ appendix I, for additional information about changes in coding system and coding modifications for the National Hospital Discharge Survey.

44
Table 24. Number and rate of hysterectomies for female discharges from short-stay hospitals by age: United States, 1980, 1985, and

1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Data are for International Classification of Diseases, 9th Revision, Clinical Modification

codes 68.3–68.7]

Year

All

ages1

15–29

years

30–49

years

50 years

and over

All

ages1

15–29

years

30–49

years

50 years

and over

Number in thousands Rate per 100,000 female population

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 649 84 409 157 556.5 272.4 1,471.2 474.8

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 670 74 440 156 549.3 242.7 1,372.6 453.6

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 578 52 390 137 461.8 175.1 1,110.5 389.7

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541 48 355 138 427.8 165.9 982.6 389.1

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 591 51 396 144 463.1 177.6 1,068.2 404.8

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 546 37 375 135 423.4 131.3 983.1 374.8

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 580 44 387 149 444.7 159.1 990.1 409.5

1Includes age groups not shown in table.

45
Table 25. Number and rate of selected obstetrical procedures for females with deliveries discharged from short-stay hospitals by type of

procedure: United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Procedure groupings and code numbers are based on the International Classification of Diseases, 9th Revision,

Clinical Modification (ICD–9–CM). Data are for selected procedures performed on discharges with code V27, females with deliveries]

Procedure category and ICD–9–CM code 1980 1985 1988 1989 1990 1991 1992

Number of all-listed procedures in thousands

Episiotomy .................... 72.1,72.21,72.31,72.71,73.6 2,012 1,820 1,679 1,703 1,714 1,683 1,609

Fetal EKG and fetal monitoring, not otherwise specified . . 75.32,75.34 106 250 1,094 1,147 1,306 1,259 1,180

Cesarean section .................... 74.0–74.2,74.4,74.99 619 877 933 937 945 933 921

Manually assisted delivery .......................... 73.5 70 193 628 638 750 792 806

Repair of current obstetric laceration ............... 75.5–75.6 350 543 684 759 789 790 785

Artificial rupture of membranes ....................... 73.0 120 315 585 652 691 774 727

Medical induction of labor .......................... 73.4 42 66 152 196 225 258 276

Vacuum extraction1 .............................. 72.7 22 66 114 156 190 223 238

Forceps delivery1 ............. 72.0–72.4,72.51,72.53,72.6,73.3 555 376 294 294 269 230 220

Rate per 100 deliveries2

Fetal EKG and fetal monitoring, not otherwise specified . . 75.32,75.34 2.8 6.5 28.9 29.1 32.4 31.7 30.2

Cesarean section .................... 74.0–74.2,74.4,74.99 16.5 22.7 24.7 23.8 23.5 23.5 23.6

Artificial rupture of membrane ....................... 73.0 3.2 8.2 15.5 16.6 17.2 19.5 18.6

Medical induction of labor .......................... 73.4 1.1 1.7 4.0 5.0 5.6 6.5 7.1

Rate per 100 vaginal deliveries3

Episiotomy .................... 72.1,72.21,72.31,72.71,73.6 64.0 61.1 59.0 56.8 55.7 55.4 53.8

Manually assisted delivery .......................... 73.5 2.2 6.5 22.1 21.3 24.3 26.0 27.0

Repair of current obstetric laceration ............... 75.5–75.6 11.1 18.2 24.0 25.3 25.6 26.0 26.3

Vacuum extraction1 .............................. 72.7 0.7 2.2 4.0 5.2 6.2 7.3 8.0

Forceps delivery1 ............. 72.0–72.4,72.51,72.53,72.6,73.3 17.7 12.6 10.3 9.8 8.7 7.6 7.4

1Vacuum extraction and forceps delivery with episiotomy are also included in the episiotomy category.

2Per 100 discharges with ICD–9–CM code V27, females with deliveries.

3Per 100 discharges with ICD–9–CM code V27, excluding those with a cesarean section.

46
Table 26. Number and rate of cesarean sections for females with deliveries discharged from short-stay hospitals by age: United States,

1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Data are coded based on the International Classification of Diseases, 9th Revision, Clinical Modification. Includes

female discharges with diagnostic code V27 and procedure codes 74.0–74.2, 74.4, and 74.99]

Year

All

ages

Under

20 years

20–24

years

25–29

years

30–34

years

35 years

and over

Number in thousands

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 619 85 194 199 107 35

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 877 77 243 288 192 76

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 933 94 206 322 217 94

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 937 89 224 312 210 103

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 945 89 219 287 238 113

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 933 98 218 283 227 107

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 921 86 220 264 230 120

Rate per 100 deliveries

1980 ....................................... 16.5 14.5 15.8 16.7 18.0 20.6

1985 ....................................... 22.7 16.1 21.2 22.9 26.6 30.7

1988 ....................................... 24.7 19.5 20.1 26.7 28.0 32.1

1989 ....................................... 23.8 18.1 21.1 24.8 26.6 30.3

1990 ....................................... 23.5 16.6 21.0 23.3 27.8 31.4

1991 ....................................... 23.5 18.2 21.0 24.3 26.6 28.4

1992 ....................................... 23.6 17.5 21.4 23.2 27.1 30.1

47
Table 27. Number and rate of prostatectomies for male discharges from short-stay hospitals by age: United States, 1980, 1985, and

1988–92

[Discharges of inpatients from non-Federal hospitals. Data are for International Classification of Diseases, 9th Revision, Clinical Modification codes 60.2–60.6]

Year

All

ages1

45–64

years

65 years and over

Total

65–74

years

75 years

and over

Number in thousands

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335 83 251 139 112

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367 81 284 150 134

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358 67 290 146 144

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376 71 304 162 143

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364 80 284 159 125

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363 68 295 158 138

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353 74 278 148 131

Rate per 100,000 male population

1980 .............................. 307.5 392.1 2,423.0 2,051.2 3,128.5

1985 .............................. 321.2 382.0 2,495.9 2,041.6 3,318.4

1988 .............................. 304.1 309.9 2,394.2 1,892.4 3,276.0

1989 .............................. 316.9 322.5 2,468.9 2,064.9 3,170.0

1990 .............................. 302.8 357.9 2,261.5 2,003.6 2,703.4

1991 .............................. 299.1 302.7 2,308.8 1,965.1 2,887.0

1992 .............................. 286.6 318.3 2,131.5 1,815.5 2,653.4

1Includes age groups not shown in table.

48
Table 28. Number of male newborn infants and number and percent circumcised in short-stay hospitals by region: United States, 1980,

1985, and 1988–92

[Infants born in non-Federal hospitals. Circumcision data are for International Classification of Diseases, 9th Revision, Clinical Modification code 64.0]

Year

United

States Northeast Midwest South West

Number of male newborn infants in thousands

1980 .............................. 1,950 376 531 676 366

1985 .............................. 1,953 339 469 701 445

1988 .............................. 1,882 373 443 614 452

1989 .............................. 1,989 392 481 643 472

1990 .............................. 1,982 379 449 693 461

1991 .............................. 2,003 366 465 685 487

1992 .............................. 1,926 365 424 656 482

Number circumcised in thousands

1980 .............................. 1,261 253 403 379 226

1985 .............................. 1,163 221 331 393 218

1988 .............................. 1,092 235 322 330 204

1989 .............................. 1,170 248 356 372 194

1990 .............................. 1,169 238 341 396 195

1991 .............................. 1,224 228 363 436 197

1992 .............................. 1,170 247 331 411 181

Percent circumcised

1980 .............................. 64.7 67.4 75.9 56.0 61.8

1985 .............................. 59.5 65.2 70.6 56.0 49.0

1988 .............................. 58.0 63.2 72.7 53.8 45.2

1989 .............................. 58.8 63.2 74.0 57.9 41.0

1990 .............................. 59.0 62.6 76.0 57.1 42.4

1991 .............................. 61.1 62.4 78.2 63.6 40.4

1992 .............................. 60.7 67.6 78.2 62.7 37.5

49
Table 29. Number and rate of open-heart surgeries for discharges from short-stay hospitals, by sex and age: United States, 1980, 1985,

and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Data are for International Classification of Diseases, 9th Revision, Clinical Modification

codes 35.1–35.51, 35.53–35.95, 35.98–35.99, 36.2, 36.9, 37.10–37.11, 37.32–37.33, and 37.4–37.5]

Sex and year

All

ages

Under 45

years

45–64

years

65 years

and over

All

ages

Under

45 years

45–64

years

65 years

and over

Both sexes Number in thousands Rate per 100,000 population

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 20 18 16 23.8 12.7 41.6 60.4

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 22 20 25 28.6 13.4 45.1 89.6

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 30 28 34 37.8 18.0 61.0 112.6

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 33 19 39 37.3 19.7 42.0 126.5

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 33 23 47 41.8 19.6 49.4 151.2

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 32 24 41 38.9 18.6 52.2 129.0

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 33 25 46 41.2 19.3 51.1 143.7

Male

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 10 9 *7 24.0 12.4 43.9 69.3

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 12 10 13 30.4 14.6 47.9 111.2

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 18 14 21 45.0 21.2 65.9 171.8

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 18 11 17 38.4 20.9 51.5 134.8

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 18 14 23 45.7 21.5 63.3 179.6

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 18 12 19 39.8 20.6 51.4 148.8

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 19 13 24 46.0 21.8 57.8 186.0

Female

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 10 9 *8 23.7 13.0 39.4 54.5

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 10 10 13 26.8 12.3 42.4 75.2

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 12 13 13 31.0 14.8 56.4 73.0

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 16 *8 22 36.2 18.5 33.3 121.0

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 15 *9 25 38.0 17.8 36.5 132.1

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 14 13 22 38.1 16.7 53.0 115.7

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 14 11 22 36.6 16.7 44.8 115.0

*Figure does not meet standard of reliability or precision.

50
Table 30. Number and rate of removal of coronary artery obstructions for discharges from short-stay hospitals by sex and age: United

States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Data are for International Classification of Diseases, 9th Revision, Clinical Modification

code 36.0]

Sex and year

All

ages1

45–64

years

65 years and over

All

ages1

45–64

years

65 years and over

Total

65–74

years

75 years

and over Total

65–74

years

75 years

and over

Both sexes Number in thousands Rate per 100,000 population

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *6 * * * – *2.6 * * * –

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 47 23 20 * 34.7 105.4 82.5 118.4 *

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 117 92 71 21 93.3 257.9 304.5 401.7 167.3

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 133 107 74 33 105.6 289.8 348.9 412.0 261.0

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 148 115 89 26 115.2 320.4 368.3 490.3 200.0

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331 163 143 98 45 131.9 350.0 449.1 536.5 330.5

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399 177 192 129 63 157.2 366.2 594.4 699.9 453.6

Male

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *5 * * * – *4.6 * * * –

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 34 13 11 * 50.4 162.1 115.2 153.2 *

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 88 58 46 12 136.1 403.5 475.6 594.6 266.6

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 100 61 42 19 149.1 453.5 497.1 539.4 423.7

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 111 72 58 15 166.8 498.3 575.7 725.4 319.0

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 119 84 60 24 183.5 530.3 654.8 746.6 500.2

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 127 110 79 31 213.3 546.5 842.4 976.0 621.7

Female

1980 .............................. * – * * – * – * * –

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 12 10 *9 * 19.9 53.7 60.5 *91.5 *

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 29 34 25 9 53.1 124.2 189.6 251.8 113.5

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 33 46 31 14 64.7 138.8 249.3 312.7 172.7

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 37 43 31 12 66.6 155.9 228.7 306.8 135.3

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 44 59 38 21 83.3 183.0 310.4 372.1 237.5

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 50 82 50 32 104.3 198.6 426.3 482.9 360.6

1Includes age groups not shown in table.

* Figure does not meet standard of reliability or precision.

- Quantity zero.

51
Table 31. Number and rate of discharges from short-stay hospitals with one or more coronary artery bypass grafts by sex and age:

United States, 1980, 1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Data are for discharges with International Classification of Diseases, 9th Revision,

Clinical Modification code 36.1]

Sex and year

All

ages1

45–64

years

65 years and over

All

ages1

45–64

years

65 years and over

Total

65–74

years

75 years

and over Total

65–74

years

75 years

and over

Both sexes Number in thousands Rate per 100,000 population

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 87 38 33 *5 60.2 195.6 149.1 212.5 *50.4

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 109 79 61 18 85.2 245.1 278.7 361.6 157.6

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 111 130 101 29 104.0 244.9 430.3 572.8 229.3

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 113 138 102 36 105.9 246.1 449.0 569.0 281.8

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 108 143 93 50 105.9 233.6 457.6 516.0 377.1

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 111 140 97 44 105.8 237.2 442.3 530.4 322.8

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 125 174 118 56 121.9 259.7 539.4 641.3 403.4

Male

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 71 27 23 * 97.7 334.9 256.7 345.9 *

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 88 51 41 11 131.5 412.9 450.2 552.9 264.3

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 88 91 75 16 160.9 402.7 755.2 976.2 367.0

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 88 90 67 23 156.6 402.3 729.4 861.9 499.4

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 83 95 66 30 156.6 375.2 757.2 826.2 638.7

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 83 93 67 27 153.8 371.5 730.0 831.8 558.8

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 100 113 79 34 179.8 429.1 864.5 971.6 687.7

Female

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 16 12 10 * 25.1 69.4 76.3 110.3 *

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 21 28 20 *8 41.8 92.0 163.9 214.2 *100.0

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 24 38 26 13 50.7 99.9 212.2 259.1 154.9

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 24 48 34 14 58.3 102.0 260.6 340.8 163.7

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 25 48 28 20 58.2 102.7 256.1 273.9 234.7

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 27 47 30 17 60.5 112.9 248.3 294.6 193.6

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 26 61 39 22 67.2 102.1 319.0 381.5 246.3

*Figure does not meet standard of reliability or precision.

1Includes age groups not shown in table.

NOTE: Patients that had more than one coronary artery bypass graft during a single operation were counted once in this table. For number and rate of coronary artery bypass procedures, see

tables 18–23. See appendix II.

52
Table 32. Number and rate of cardiac catheterizations for discharges from short-stay hospitals by sex and age: United States, 1980,

1985, and 1988–92

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants. Data are for International Classification of Diseases 9th Revision, Clinical Modification

codes 37.21–37.23]

Sex and year

All

ages1

15–44

years

45–64

years

65 years and over

All

ages1

15–44

years

45–64

years

65 years and over

Total

65–74

years

75 years

and over Total

65–74

years

75 years

and over

Both sexes Number in thousands Rate per 100,000 population

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348 51 187 84 71 13 154.4 49.4 420.3 326.5 454.3 127.7

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 681 79 350 227 178 50 288.1 71.1 785.0 800.3 1,055.1 428.7

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 930 93 432 385 286 99 382.9 81.4 951.4 1,276.6 1,620.0 792.3

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 958 95 425 414 306 108 390.7 82.7 927.9 1,350.5 1,714.4 843.4

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 995 100 457 421 296 125 401.8 86.0 988.5 1,348.4 1,637.0 950.8

1991 .............................. 1,000 89 447 446 296 150 399.1 75.9 956.3 1,404.8 1,620.7 1,111.8

1992 .............................. 1,028 95 432 486 330 156 405.6 81.3 893.8 1,506.3 1,787.5 1,130.8

Male

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 35 129 52 46 *6 209.6 68.0 611.2 501.3 673.9 173.9

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439 58 241 126 102 24 384.6 104.8 1,135.4 1,106.5 1,390.5 592.1

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 598 67 296 222 172 49 508.4 118.4 1,361.2 1,831.0 2,232.4 1,125.6

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 601 70 291 230 175 55 506.1 122.3 1,321.5 1,861.6 2,234.8 1,213.8

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 620 68 306 236 170 66 515.8 118.1 1,379.3 1,879.8 2,143.7 1,426.8

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 603 61 296 235 169 66 496.0 105.7 1,317.4 1,835.5 2,106.5 1,379.5

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 636 71 291 266 194 72 517.1 122.1 1,251.2 2,040.7 2,387.1 1,468.7

Female

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 17 58 32 25 *7 102.9 31.3 247.4 208.4 286.1 102.1

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 22 108 101 76 26 197.8 38.3 465.2 595.5 796.6 340.4

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332 26 136 163 113 50 265.2 45.1 574.7 904.4 1,143.8 611.9

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357 26 135 185 131 53 282.3 43.9 565.0 1,007.1 1,308.9 642.5

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376 32 151 185 126 59 294.5 54.4 627.1 991.0 1,241.3 691.7

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397 27 151 211 127 84 307.9 46.5 621.9 1,114.2 1,240.7 965.1

1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392 24 141 220 136 84 300.4 41.0 561.4 1,144.0 1,316.1 944.1

*Figure does not meet standard of reliability or precision.

1Includes age groups not shown in table.

53
Appendixes

Contents

I. Technical notes on methods .......................................................................... 55

Statistical design of the National Hospital Discharge Survey............................................. 55

Data collection and processing ..................................................................... 56

Presentation of estimates.......................................................................... 59

Estimation procedures ............................................................................ 61

Reliability of estimates ........................................................................... 62

Weighted least squares as a test for trend ............................................................ 64

Tests of significance ............................................................................. 66

II. Definitions of terms ................................................................................ 67

Terms relating to hospitalization.................................................................... 67

Terms relating to diagnoses ....................................................................... 67

Terms relating to procedures....................................................................... 67

Demographic terms .............................................................................. 68

III. Recent publications from the National Hospital Discharge Survey .......................................... 70

Appendix figure

I. Medical abstract for the National Hospital Discharge Survey, 1992 .......................................... 57

Appendix tables

I. Number of hospitals in the National Hospital Discharge Survey universe and sample, number of in-scope and

responding sample hospitals, response rates, and number of abstracts collected: 1980, 1985, and 1988–92 .......... 56

II. Conversion table of changes in diagnosis codes that affect diagnostic categories in this report .................... 58

III. Conversion table of changes in procedure codes that affect procedure categories in this report .................... 59

IV. Civilian population by age, sex, and geographic region: United States, 1980, 1985, and 1988–92.................. 60

V. Rate of discharges from short-stay hospitals reported in annual summary and revised using population based on 1990

census by sex and age: United States, 1985 and 1988–90 ................................................. 61

VI. Approximate relative standard errors of estimated number of discharges or first-listed diagnoses by size of estimate:

1980 and 1985..................................................................................... 63

VII. Approximate relative standard errors of estimated number of days of care by size of estimate: 1980 and 1985 ....... 63

VIII. Approximate relative standard errors of estimated number of procedures by size of estimate: 1980 and 1985 ........ 63

IX. Estimated parameters for approximate relative standard error equations for number of discharges or first-listed

diagnoses by selected characteristics: 1988–92 ........................................................... 64

X. Estimated parameters for approximate relative standard error equations for number of days of care by selected

characteristics: 1988–92 ............................................................................. 64

XI. Estimated parameters for approximate relative standard error equations for number of procedures by selected

characteristics: 1988–92 ............................................................................. 65

XII. Worksheet for weighted least squares regression of discharge rate on year: United States, 1988–92 ................ 66

XIII. Code numbers for class 4 procedures and year first used to code data from the National Hospital Discharge Survey . . 68

XIV. Code numbers for procedures considered nonsurgical in the National Hospital Discharge Survey, by chapter and

year ............................................................................................. 69

XV. Standard million age distribution used to adjust rates to the U.S. civilian population on July 1, 1980............... 69

54
Appendix I

Technical notes on methods

Statistical design of the National Hospital

Discharge Survey

Scope of the survey

The National Hospital Discharge Survey (NHDS) covers

discharges from noninstitutional hospitals, except Federal,

military, and Department of Veterans Affairs hospitals, located

in the 50 States and the District of Columbia. Only hospitals

with at least six beds and an average length of stay of less than

30 days for all patients were included in the survey from

1965–87. Beginning in 1988, the universe also included

hospitals whose specialty was general (medical or surgical) or

children’s general, even if the hospital’s average length of stay

was 30 days or more.

NHDS history

The National Center for Health Statistics (NCHS) has

conducted the NHDS continuously since 1965. The original

sample was selected in 1964 from a frame of short-stay

hospitals listed in the National Master Facility Inventory. That

sample was updated periodically with samples of newly

opened hospitals. Sample hospitals were selected with probabilities ranging from certainty for the largest hospitals to 1 in

40 for the smallest hospitals. Within each sample hospital, a

systematic random sample of discharges was selected. A

description of the development and design of the original

NHDS has been published (12).

Until 1985, all data were collected by a manual system in

which sample selection and transcription of information were

done manually. Starting in 1985, some data were also collected by using an automated system whereby NCHS purchased data tapes containing discharge medical abstracts from

commercial abstracting services and State data systems. Samples

were selected from these tapes.

In 1988, NCHS redesigned the NHDS to link it with other

surveys conducted by NCHS and to improve efficiency through

use of information and technologies not available when the

survey was designed in 1964. Details of the new design are

outlined below.

The changes in the survey may affect trend data. That is,

some of the differences between NHDS estimates based on the

1965–87 design and estimates based on the new design may

be due to survey redesign rather than to changes in hospital

utilization. A report describing the two survey designs and

discussing the effects of the design changes on estimates from

the survey has been published (13).

New sampling design

The 1988 sampling frame consisted of hospitals that were

listed in the April 1987 SMG Hospital Market Database (14)

and that began to accept inpatients by August 1987. The

sampling frame was updated in 1991 to include hospitals from

the 1991 SMG Hospital Market Database (15). The NHDS

sample includes with certainty all hospitals with 1,000 beds or

more or 40,000 discharges or more annually. The remaining

sample of hospitals is based on a stratified three-stage design.

The first stage consists of 112 primary sampling units

(PSU’s) that comprise a probability subsample of PSU’s used

in the 1985–94 National Health Interview Survey (NHIS). The

PSU’s are counties, groups of counties, county equivalents

(such as parishes or independent cities), or towns and townships (for some PSU’s in New England). The NHDS sample

includes with certainty the 26 PSU’s with the largest populations. In addition, the sample includes half of the next 26

largest PSU’s and one PSU from each of 73 PSU strata formed

from the remaining PSU’s for the NHIS sample design. Those

73 PSU strata were defined within four geographical regions

and were assigned metropolitan statistical area (MSA) or

non-MSA status by using 1980 census data and a computer

program that minimized the between-PSU variances for NHIS

stratification variables. (MSA is a metropolitan statistical area

defined by the U.S. Office of Management and Budget on the

basis of the 1980 Census.) From the 73 strata thus formed, the

PSU’s were selected with probability proportional to the

projected 1985 population. A more detailed analysis of the

NHIS PSU sample design is presented in a series 2, Vital and

Health Statistics report (25).

The second stage consists of noncertainty hospitals selected

from the sample PSU’s. To ensure distribution of the sample

across PSU’s and to maximize the potential for automated data

collection, the noncertainty hospitals in those PSU’s were

stratified. The strata were defined by region, PSU, and in the

12 largest PSU’s by abstracting status (whether the hospital

subscribed to a commercial abstracting service). Within the

strata, the hospitals were ordered by PSU, abstracting service

status, and hospital specialty-size groups. Group 1 consisted of

hospitals with 6–999 beds that specialized in psychiatry,

tuberculosis and other respiratory diseases, rehabilitation,

chronic disease, mental retardation, alcoholism and other

55
chemical dependencies, or children’s psychiatry. Groups 2–4

included general medical and surgical hospitals and specialty

hospitals other than those in group 1. Group 2 hospitals had

6–174 beds, group 3 hospitals had 175–349 beds, and group 4

hospitals had 350–999 beds.

Within each specialty-size group, hospitals were arrayed

by their annual numbers of discharges recorded in the April

1987 SMG Hospital Market Database. Hospitals were then

selected from each stratum’s ordered array by systematic

random sampling with probability proportional to their SMGrecorded 1987 annual numbers of discharges. At least three

hospitals were selected from every PSU containing three

eligible hospitals or more. In PSU’s with fewer than three

hospitals, all hospitals in the PSU were selected.

For 1992, the sample consisted of 528 hospitals. Of the

528 hospitals, 14 were found to be out of scope (ineligible)

because prior to 1992 they went out of business or otherwise

failed to meet the criteria for the NHDS universe. Of the 514

in-scope (eligible) hospitals, 494 hospitals responded (NCHS

collected data for at least half of the number of sample

discharges expected in half or more of the months these

hospitals were in scope). The number of hospitals in the

universe, the sample, and the responding sample are shown for

1980, 1985, and 1988–92 in table I.

At the third stage, a sample of discharges from each

hospital was selected by a systematic random sampling technique. For hospitals using the manual system of data collection, the discharges were selected at the hospital from daily

listing sheets, computer files, or other lists in which discharges

were listed in some chronological order. For most of these

hospitals, the sample discharges were selected on the basis of

the terminal digit(s) of the patient’s medical record. In some

cases, an admission number, billing number, or other number

was used. If no patient numbers useful for sampling purposes

were available in a hospital’s list of discharges, the sample

was selected by starting with a randomly selected discharge

and taking every kth discharge thereafter.

For hospitals whose data were collected via the automated

system, the discharges were selected by NCHS from discharge

medical abstract files after sorting by the first two digits of the

ICD–9–CM code of the first-listed diagnosis, the patient’s age

at time of admission (under 1 year, 1–14 years, 15–44 years,

45–64 years, 65–74 years, 75–84 years, 85 years and over, and

age unknown), the patient’s sex, and the date of discharge.

These samples were selected by starting with a randomly

selected discharge and taking every kth discharge thereafter.

The third-stage sampling rate was determined by the

hospital’s sampling stratum and the system (manual or automated) used to collect data from the hospital. One percent and

5 percent of discharges in the certainty hospitals were selected

under the manual and automated systems, respectively. Except

for certainty hospitals, the target sample size was 250 discharges each from all manual system hospitals and from the

automated system hospitals that had fewer than 4,000 discharges annually according to the 1987 sampling frame data.

Samples of 2,000 were targeted for each of the remaining

noncertainty automated system hospitals. The final sample for

1992 included 274,000 discharge medical record abstracts.

The number of abstracts collected for 1980, 1985, and 1988–92

are shown in table I.

Data collection and processing

Data collection

Two data collection procedures were used for the survey.

One was a manual system of sample selection and data

abstraction. The other, first used in 1985, was an automated

system involving the purchase of data tapes from abstracting

service organizations and selected State systems. The automated system was used by 17 percent of respondent hospitals

in 1985 and by 33–37 percent in 1988–92.

In the manual system, the sample selection and the

transcription of information from the hospital records to

abstract forms were performed at the hospitals. The completed

forms, along with sample selection control sheets, were then

forwarded to NCHS for coding, editing, and weighting. A few

of these hospitals submitted their data via computer printout or

tape. In 1980, 1985, and 1988–92, half to two-thirds of the

hospitals participating in the manual system had the work

Table I. Number of hospitals in the National Hospital Discharge Survey universe and sample, number of in-scope and responding sample

hospitals, response rates, and number of abstracts collected: 1980, 1985, and 1988–92

Year Universe

Total

sample

Sample

in-scope1 Respondents2

Response

rate

Abstracts

collected

Number of hospitals Percent Number

1980 .............................. 3

8,017 544 492 420 85 224,000

1985 .............................. 6,007 558 496 414 83 195,000

1988 .............................. 6,400 542 531 422 79 250,000

1989 .............................. 6,400 542 526 408 78 233,000

1990 .............................. 6,400 542 519 474 91 266,000

1991 .............................. 6,250 528 521 484 93 274,000

1992 .............................. 6,250 528 514 494 96 274,000

1Excludes hospitals that were out of business for the whole year or that failed to meet the definition of a short-stay hospital in 1980 and 1985, or of a general, children’s general, or short-stay

hospital in 1988–92.

2In 1980 and 1985, all hospitals participating in the survey; in 1988–92, hospitals for which data were collected by the National Center for Health Statistics for at least half the number of sample

discharges expected in half or more of the months the hospitals were in scope.

3All hospitals added to universe from 1965–79, including those that had gone out of business, which were excluded from totals in 1985 and 1988–92.

56
Figure I. Medical abstract for the National Hospital Discharge Survey, 1992

57
performed by their own medical records staff. In the remaining

hospitals using the manual system, personnel of the U.S.

Bureau of the Census did this work on behalf of NCHS. For

the automated system, NCHS purchased tapes containing

machine-readable medical record data and selected sample

discharges from these tapes.

The medical abstract form (figure I) and the abstract

service data tapes contain items relating to the personal

characteristics of the patient. These items include birth date,

sex, race, ethnicity, marital status, ZIP Code (but not name or

address), and expected sources of payment. Administrative

data such as admission and discharge dates, discharge status,

and medical record number are also included. The medical

information about patients includes diagnoses, surgical and

nonsurgical operations and procedures, and dates of surgery.

These data items conform with the Uniform Hospital Discharge Data Set (UHDDS)(26). The PSU, hospital name,

medical record number, date of birth, and patient ZIP Code are

confidential information not available to the public.

Medical coding and edit

The medical information recorded on the sample patient

abstracts, collected by the manual system, was coded by

NCHS staff. A maximum of seven diagnostic codes were

assigned for each sample abstract. In addition, if the medical

information included surgical or nonsurgical procedures, a

maximum of four codes for these procedures were assigned.

The system currently used for coding the diagnoses and

procedures is the International Classification of Diseases, 9th

Revision, Clinical Modification, or ICD–9–CM (16).

Although the ICD–9–CM has been used for coding NHDS

data since 1979, it should be noted that this coding system is

not static, but undergoes periodic updating. Beginning in

1986, addenda to the ICD–9–CM have been published annually and go into effect on October 1. They include additions,

deletions, and changes in codes or titles. The actual dates

when these coding changes went into effect in the NHDS

varied over time and by source of data. For 1988–91, part of

the data for certain hospitals were coded according to that

year’s addenda, but the addenda changes were not fully

implemented until the following year. To improve the consistency of the coding, beginning with the 1992 data, no use was

made of the addenda until the beginning of the calender year

following their effective date. Thus, the 1992 data were coded

using the 1986–91 addenda, and the 1992 addenda were not

used until 1993 data were coded.

Changes in codes affecting diagnostic or procedure categories in this report are shown in tables II and III. These

conversion tables show the new ICD–9–CM codes from

1986–91 addenda, the date the codes were introduced, and the

code to which the diagnosis or procedure had been assigned

prior to the development of the new code. Information about

all coding changes in the 1986–91 addenda has been published

(27).

Among the changes affecting categories in this report was

the 1987 revision of ICD–9–CM code 33.27 from ‘‘other

biopsy of lung,’’ to ‘‘closed endoscopic biopsy of lung.’’

Before 1987, code 33.27 was not included in the category,

‘‘bronchoscopy with or without biopsy,’’ but after the revision

it was included.

The codes for joint replacement, revision, and arthroplasty were substantially revised in the 1989 addenda. ‘‘Total

knee replacement,’’ which had been coded 81.41, was changed

to 81.54. ‘‘Total hip replacement,’’ which had been coded

81.51 and 81.59 became 81.51 only; 81.59 was redefined to

‘‘revision of joint replacement not otherwise classified.’’ Because

there were two definitions for code 81.59 during 1989, it was

not possible to make an estimate of total hip replacement for

that year.

In the 1991 addenda, code 93.92, ‘‘other mechanical

assistance to respiration,’’ was deleted from the respiratory

therapy category and new codes 96.70–96.72 for ‘‘other

continuous mechanical ventilation’’ were added to the coding

system. These new codes were included in the ‘‘respiratory

therapy’’ category in this report.

Table II. Conversion table of changes in diagnosis codes that

affect diagnostic categories in this report

[Codes are based on the International Classification of Diseases, 9th Revision,

Clinical Modification (ICD–9–CM)]

Current code(s)

assignment

Effective

October 1

Previous code(s)

assignment

042.0–042.9 .................. 1986 279.19

043.0–043.9 .................. 1986 279.19

044.0–044.9 .................. 1986 279.19

203.01 ...................... 1991 V10.79

203.11 ...................... 1991 V10.79

203.81 ...................... 1991 V10.79

204.01 ...................... 1991 V10.61

204.11 ...................... 1991 V10.61

204.21 ...................... 1991 V10.61

204.81 ...................... 1991 V10.61

204.91 ...................... 1991 V10.61

205.01 ...................... 1991 V10.62

205.11 ...................... 1991 V10.62

205.21 ...................... 1991 V10.62

205.31 ...................... 1991 V10.62

205.81 ...................... 1991 V10.62

205.91 ...................... 1991 V10.62

206.01 ...................... 1991 V10.63

206.11 ...................... 1991 V10.63

206.21 ...................... 1991 V10.63

206.81 ...................... 1991 V10.63

206.91 ...................... 1991 V10.63

207.01 ...................... 1991 V10.69

207.11 ...................... 1991 V10.69

207.21 ...................... 1991 V10.69

207.81 ...................... 1991 V10.69

208.01 ...................... 1991 V10.60

208.11 ...................... 1991 V10.60

208.21 ...................... 1991 V10.60

208.81 ...................... 1991 V10.60

208.91 ...................... 1991 V10.60

411.81 ...................... 1989 410.9

429.71 ...................... 1989 410.0–410.9

429.79 ...................... 1989 410.0–410.9

518.81 ...................... 1987 799.1

569.84 ...................... 1990 557.1

58
With two exceptions, the order of diagnoses and procedures for sampled discharges is preserved to reflect the order

on the medical record face sheet or in the abstracting service

file. One exception is for women admitted for delivery. In this

case, a code of V27 from the supplemental classification is

assigned as the first-listed code in order to provide an estimate

of all deliveries. In the other exception, whenever an acute

myocardial infarction is encountered with other circulatory

diagnoses and is other than the first entry, it is reordered to the

first position.

An ongoing quality control program is undertaken on the

coding and entering of data from abstracts to machinereadable form. Approximately 5 percent of the abstracts are

independently recoded by an NHDS coder, with discrepancies

resolved by the chief coder. Overall error rates for records

manually coded by NCHS for the 1988–92 data years ranged

from 1.6 to 3.5 percent for medical (ICD–9–CM) coding and

entering and from 0.4 to 0.8 percent for demographic coding

and entering.

Following conversion of the data on the medical abstract

to computer tape and combining the data with the automated

data tapes, a final medical edit was performed by computer

inspection and by a manual review of rejected abstracts. If the

sex or age of the patient was incompatible with the recorded

medical information, priority was given to the medical

information.

Presentation of estimates

Grouping of diagnoses and procedures

In this report, the broadest groupings of diseases and

injuries shown correspond to the ICD–9–CM chapters 1–17

and the supplementary classification of factors influencing

health status and contact with health services. Diagnostic

categories, the most detailed groupings of diseases and injuries

shown, are subsets of the major groups or chapters.

The procedure groupings used in this report are the

groups numbered 1–16 in the ICD–9–CM section entitled

‘‘Procedure Classification.’’ Specific categories of operations

or procedures, the most detailed of these groups shown, are

subsets of the major groups.

In developing tables of diagnoses and of procedures, an

effort was made to present data for the most frequently

occurring conditions or procedures, as well as those of significant public health interest. The diagnostic and procedure

categories in tables 8–16 and 18–23 are the same categories

shown in the 1990–93 NHDS annual summaries published in

Advance Data From Vital and Health Statistics and series 13

of Vital and Health Statistics.

Patient characteristics not stated

Age or sex of the patient was not stated for 0.5 to

2 percent of sample discharges for 1988–92. These data were

imputed by assigning the patient an age or sex consistent with

the age or sex of other sampled patients with the same

diagnostic code. In addition to the edits performed by NCHS,

data obtained through the automated system may have been

edited by an abstract service and may have had data imputed.

The extent of this imputation, if any, is unknown.

Rounded numbers

Estimates in this report have been rounded. Therefore,

detailed figures may not add to totals. Rates and percents were

calculated using unrounded figures and may not agree with

computations made from the rounded data.

Population estimates

The population estimates used in computing rates are

from published and unpublished estimates for the U.S. civilian

population, including institutionalized persons, on July 1 of

the data year provided by the U.S. Bureau of the Census. The

estimates by age, sex, and geographic region are presented in

table IV and are consistent with population estimates published in Current Population Reports, Series P-25.

The population estimates in table IV are based on the

1990 census as enumerated. They are generally somewhat

smaller than the population estimates used in the NHDS

annual summaries for 1985 and 1988–90 (28–31), which were

based on the 1980 census. As a result, the population-based

rates in this report are generally slightly higher than the

previously reported rates for 1985 and 1988–90 (table V),

although the differences are not statistically significant. The

Table III. Conversion table of changes in procedure codes that

affect procedure categories in this report

[Codes are based on the International Classification of Diseases, 9th Revision,

Clinical Modification (ICD–9–CM)]

Current code(s)

assignment

Effective

October 1

Previous code(s)

assignment

29.31 ............. 1991 83.02

33.27 ............. 1987 33.22+33.27

33.28 ............. 1987 33.27

35.96 ............. 1986 35.03

36.04 ............. 1986 39.97

37.79 ............. 1987 86.09

44.44 ............. 1989 38.86

45.16 ............. 1988 45.14 (45.15 before 1987)

45.75 (Hartmann

resection added) .... 1988 48.66 (code deleted)

56.35 ............. 1987 45.12

77.56 ............. 1989 77.89,78.49,81.18

77.57 ............. 1989 77.89,80.48,81.18,83.85

81.51 ............. 1989 81.51,81.59

81.53 ............. 1989 81.51,81.59,81.61,81.62,

81.63,81.64

81.54–81.55 ........ 1989 81.41

86.27 ............. 1986 86.22–86.23

86.28 ............. 1988 86.22

96.70 ............. 1991 93.92 (code deleted)

96.71 ............. 1991 93.92 (code deleted)

96.72 ............. 1991 93.92 (code deleted)

97.05 ............. 1989 51.97

98.51–98.52 ........ 1989 59.96 (code deleted)

98.59 ............. 1989 59.96 (code deleted)

59
Table IV. Civilian population by age, sex, and geographic region: United States, 1980, 1985, and 1988–92

[Population estimates consistent with Series P-25, Current Population Reports, U.S. Bureau of the Census]

Age, sex, and geographic region 1980 1985 1988 1989 1990 1991 1992

All ages Population in thousands

Total .............................. 225,621 236,219 242,817 245,131 247,751 250,566 253,497

Sex:

Male ............................. 108,924 114,182 117,571 118,763 120,124 121,539 123,081

Female ........................... 116,697 122,037 125,246 126,368 127,627 129,027 130,416

Region:

Northeast .......................... 49,075 49,759 50,467 50,642 50,725 50,871 51,026

Midwest ........................... 58,752 58,667 59,115 59,327 59,647 60,090 60,586

South ............................ 74,886 80,526 83,026 83,830 84,872 86,067 87,299

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42,908 47,267 50,209 51,332 52,507 53,537 54,586

Under 15 years

Total .............................. 51,290 51,534 52,451 53,222 54,103 55,130 55,962

Sex:

Male ............................. 26,219 26,374 26,851 27,245 27,698 28,225 28,653

Female ........................... 25,071 25,160 25,600 25,977 26,405 26,906 27,309

Region:

Northeast .......................... 10,337 9,756 9,841 9,978 10,097 10,263 10,361

Midwest ........................... 13,589 13,080 12,974 13,113 13,226 13,350 13,422

South ............................ 17,480 17,945 18,213 18,367 18,625 18,957 19,251

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,884 10,753 11,423 11,764 12,154 12,561 12,929

15–44 years

Total .............................. 104,158 111,711 114,819 115,393 116,178 116,973 116,946

Sex:

Male ............................. 51,209 55,151 56,866 57,198 57,653 58,063 58,110

Female ........................... 52,949 56,560 57,953 58,195 58,525 58,910 58,836

Region:

Northeast .......................... 22,137 23,419 23,827 23,805 23,729 23,625 23,342

Midwest ........................... 26,985 27,325 27,510 27,455 27,522 27,676 27,641

South ............................ 34,402 37,856 38,988 39,213 39,557 39,984 40,106

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,634 23,112 24,494 24,921 25,371 25,687 25,856

45–64 years

Total .............................. 44,465 44,558 45,423 45,835 46,243 46,710 48,304

Sex:

Male ............................. 21,132 21,265 21,757 21,987 22,214 22,461 23,274

Female ........................... 23,333 23,293 23,667 23,848 24,029 24,249 25,031

Region:

Northeast .......................... 10,500 10,017 9,980 9,964 9,929 9,939 10,198

Midwest ........................... 11,450 11,010 11,077 11,104 11,144 11,206 11,561

South ............................ 14,459 15,148 15,561 15,751 15,962 16,185 16,787

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,055 8,383 8,806 9,016 9,208 9,379 9,758

65 years and over

Total .............................. 25,707 28,416 30,123 30,682 31,228 31,753 32,285

65–74 years ........................ 15,651 16,859 17,626 17,864 18,098 18,280 18,461

75 years and over .................... 10,057 11,557 12,497 12,818 13,129 13,474 13,824

Male .............................. 10,364 11,392 12,098 12,333 12,559 12,791 13,045

65–74 years ........................ 6,787 7,339 7,710 7,824 7,934 8,022 8,125

75 years and over .................... 3,577 4,053 4,388 4,509 4,626 4,769 4,920

Female ............................ 15,343 17,024 18,026 18,349 18,668 18,963 19,240

65–74 years ........................ 8,863 9,520 9,916 10,040 10,165 10,258 10,336

75 years and over .................... 6,480 7,504 8,109 8,308 8,504 8,705 8,904

Region:

Northeast .......................... 6,100 6,568 6,819 6,895 6,971 7,043 7,125

Midwest ........................... 6,728 7,251 7,554 7,655 7,755 7,857 7,962

South ............................ 8,545 9,577 10,264 10,500 10,728 10,942 11,155

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,335 5,020 5,487 5,632 5,774 5,911 6,043

60
estimate of the 1980 population changed very little when the

1990 census was taken into account. However, the rates in the

1980 annual summary (32) differ from rates presented here

because institutionalized persons were not included in the

population used to compute rates in the 1980 annual summary

(33). The populations used to compute rates in the 1991 and

1992 annual summaries (34,35) were based on the 1990

census.

Rates using civilian population estimates will be overestimated to the extent that military personnel and non-U.S.

citizens use NHDS-eligible hospitals and will be underestimates to the extent that civilians (for example, military

dependents or retirees) use hospitals that are not in the NHDS

universe, that is, hospitals that are institutional, Federal,

military, veteran, or long-stay hospitals that are not general,

maternal, or children’s general hospitals.

Published and flagged estimates

Estimates are not presented unless a reasonable assumption regarding the probability of distribution of the sampling

error is possible on the basis of the Central Limit Theorem.

The Central Limit Theorem states that, given a sufficiently

large sample size, the sample estimate approximates the

population estimate, and upon repeated sampling, its distribution would be approximately normal.

Because of the complex sample design of the NHDS,

estimates of less than 5,000 are not presented; only an asterisk

(*) appears in the tables. These estimates generally have a

relative standard error of more than 30 percent or are based on

a sample of less than 30 cases. Estimates of 5,000–9,000 are

presented with an asterisk (*) to indicate that they may not be

reliable. These estimates are generally based on less than 60

cases.

Estimation procedures

Statistics from the NHDS are derived by a multistage

estimation procedure that produces essentially unbiased national

estimates. The estimation procedure was changed as part of

the 1988 redesign of the survey. The procedure used before

1988 is described in detail in appendix I of two publications

(36,37), and is compared with the new estimation procedure in

a recent report (13).

The estimation procedure used for 1988–92 data has three

basic components: (a) inflation by reciprocals of the probabilities of sample selection, (b) adjustment for nonresponse, and

(c) population weighting ratio adjustments. The second and

third components were made separately by admission type—

that is, for discharges of newborn infants (whose hospital stay

began with their births) and for discharges of other than

newborn infants.

Inflation by reciprocals of probabilities of selection

There is one probability for each stage of sampling: (a)

the probability of selecting the PSU, (b) the probability of

selecting the hospital, and (c) the probability of selecting the

discharge within the hospital. The last probability varies

monthly and is calculated to be the sample size from the

hospital for the month divided by the total number of discharges occurring at the hospital that month. The overall

probability of selection is the product of the probabilities at

each stage. The inverse of the overall selection probability is

the basic inflation weight.

Adjustment for nonresponse

NHDS data were adjusted to account for two types of

nonresponse. The first type of nonresponse occurred when an

in-scope (NHDS-eligible) sample hospital did not respond for

Table V. Rate of discharges from short-stay hospitals reported in annual summary and revised using population based on 1990 census

by sex and age: United States, 1985 and 1988–90

[Discharges of inpatients from non-Federal hospitals. Excludes newborn infants]

Sex and age

1985 1988 1989 1990

Annual

summary Revised

Annual

summary Revised

Annual

summary Revised

Annual

summary Revised

Rate of discharges per 1,000 population

Both sexes ..................... 147.9 148.4 127.6 128.3 125.5 126.2 123.5 124.3

Under 15 years ................. 57.2 57.7 49.2 49.8 48.2 48.8 43.9 44.6

15–44 years ................... 125.1 125.0 104.0 103.9 102.8 102.7 101.7 101.6

45–64 years ................... 169.5 170.8 140.5 142.1 135.0 136.8 133.1 135.0

65 years and over ............... 368.3 369.8 334.1 336.8 330.2 333.4 327.1 330.9

Male ......................... 123.5 124.0 106.9 107.5 105.3 106.0 101.5 102.2

Under 15 years ................. 63.8 64.4 54.6 55.3 55.1 55.8 48.5 49.2

15–44 years ................... 75.4 75.3 61.5 61.3 59.8 59.5 58.0 57.8

45–64 years ................... 176.2 177.6 146.4 148.0 142.8 144.6 138.3 140.2

65 years and over ............... 393.2 397.9 360.3 367.8 354.4 363.1 346.2 356.1

Female ....................... 170.7 171.2 147.0 147.7 144.5 145.3 144.1 145.0

Under 15 years ................. 50.2 50.6 43.4 43.9 40.9 41.5 39.2 39.7

15–44 years ................... 173.4 173.5 145.6 145.8 144.9 145.1 144.5 144.7

45–64 years ................... 163.4 164.6 135.1 136.7 127.9 129.7 128.2 130.2

65 years and over ............... 351.4 351.0 316.2 316.0 313.5 313.5 313.8 314.0

61
more than half the months during which it was in scope, thus

making it a nonrespondent hospital. In this case, the weights

of discharges from hospitals similar to the nonrespondent

hospitals were inflated to account for discharges represented

by the nonrespondent hospitals. For this purpose, hospitals

were judged to be similar if they were in the same region,

hospital specialty-size group, and if possible, the same sampling stratum (that is, the same abstracting status group if the

nonrespondent hospital was in the 12 largest PSU’s and in the

same PSU, otherwise). The adjustments for this nonresponse

were made separately for admission types—that is, for discharges of newborn infants and for all other discharges. The

adjustment consisted of a ratio for which the numerator was

the weighted number of discharges of the admission type in all

similar sample hospitals (regardless of response status) and the

denominator was the weighted total of discharges of that

admission type from the hospitals similar to the nonrespondent

hospitals. Data on the number of discharges for each admission type came from either the hospitals or the 1989–93 SMG

Hospital Market Databases (15,38–41).

The second type of nonresponse occurred when NCHS

failed to collect all the discharge abstracts expected (the

number expected is the product of the hospital’s total discharges each month and the discharge sampling rate assigned

to the hospital). In each month when the hospital was respondent (at least half the expected abstracts were collected), the

weights of abstracts collected for the month were inflated to

account for the missing abstracts. For a hospital’s month(s) of

nonresponse, the weights of discharges in the hospital’s respondent months were inflated by ratios that varied with discharge

groups defined by the ICD–9–CM diagnostic classes of those

discharges’ first-listed diagnoses. The adjustment ratio for

each partially respondent hospital and each discharge group

was calculated using only data from sample hospitals that

were both NHDS eligible and respondent for all 12 months of

the data year. The ratio had as its numerator the weighted sum

of discharges in that discharge group for all months in which

the partially respondent hospital was in scope and had as its

denominator the weighted sum of discharges in that discharge

group that occurred in the months when the partially respondent hospital did not respond to the NHDS.

Population weighting ratio adjustment

Adjustments were made within each of 16 noncertainty

hospital groups defined by region and hospital specialty-size

classes to adjust for oversampling or undersampling of discharges reported in the sampling frame for the data year. For

discharges other than newborn infants, the adjustment is a

multiplicative factor that had as its numerator the number of

admissions reported for the year at sampling frame hospitals

within each region-specialty-size group and as its denominator

the estimated number of those admissions for that same

hospital group. The adjustment for discharges of newborn

infants was similar, but numbers of births were used in place

of admissions. The ratio numerators were based on the figures

obtained from the SMG Hospital Market Databases (15,38–

41) and the ratio denominators were obtained through a simple

inflation of the SMG figures for the NHDS sample hospitals.

Reliability of estimates

Nonsampling errors

As from any survey, results are subject to nonsampling

errors, which include errors due to sampling frame errors,

hospital nonresponse, missing abstracts, and recording processing errors. The magnitude of the nonsampling errors cannot be

determined. However, errors resulting from the exclusion of

in-scope hospitals from the sampling frame are believed to be

small because the hospitals excluded are ones that opened

after the frame was constructed, and hence, they tend to have

few discharges relative to hospitals that are in the frame.

Other nonsampling errors are kept to a minimum by

methods built into the survey procedures, such as training the

data collectors in sampling and data abstraction, quality checks

of sampling and abstracting, manual and computer editing,

and verification of keypunching and coding. Some nonsampling errors are discussed under ‘‘Presentation of estimates.’’

Sampling errors

Because the statistics presented in this report are based on

a sample, they may differ from the figures that would be

obtained if a complete census had been taken using the same

forms, definitions, instructions, and procedures. However, the

probability design of NHDS permits the calculation of sampling errors.

The standard error (SE) is primarily a measure of sampling variability that occurs by chance because only a sample

rather than the entire population is surveyed. The standard

error, as calculated for the NHDS, also reflects part of the

variation that arises in the measurement process, but does not

include any systematic bias.

The chances are about 68 in 100 that an estimate from the

sample would differ from a complete census by less than the

standard error. The chances are 95 in 100 that the difference

would be less than twice the standard error, and about 99 in

100 that it would be less than 2.5 times as large.

The relative standard error (RSE) of an estimate is

obtained by dividing the standard error by the estimate. The

resulting value can be multiplied by 100 to express the relative

standard error as a percent of the estimate.

Relative standard errors for aggregate estimates

Estimates of standard errors for 1980 and 1985 data were

calculated using a customized computer routine described in a

previous publication (12). Approximate relative standard errors

were calculated from these estimates and are shown in tables

VI–VIII. The approximate relative standard errors for discharges or first-listed diagnoses are in table VI, those for days

of care are in table VII, and those for procedures are in

table VIII. For the 1985 estimates and the 1980 procedure

estimates, the standard errors of regional estimates differed

from the standard errors of estimates for other characteristics

62
shown in this report. Thus, one set of approximate relative

standard errors was derived for regional estimates and another

set for the other estimates. For 1980 estimates of discharges

and days of care, only one set of approximate relative standard

errors was required for the characteristics in this report as the

standard errors computed for these characteristics were similar

to each other.

The estimated parameters for the approximate relative

standard error equations for 1988–92 aggregate statistics are

derived from standard error estimates calculated with

SESUDAAN software. SESUDAAN computes standard errors

by using a first-order Taylor series approximation of the

deviation of estimates from their expected values (42). Estimated parameters for discharges or first-listed diagnoses are

shown in table IX, those for days of care in table X, and those

for procedures in table XI. The approximate relative standard

error (RSE) of an estimate X, expressed as a percent of X, may

be calculated using the formula:

RSE(X) = 100 √a+b/X

where a, and b are as defined in tables IX–XI.

Relative standard errors for estimates of percents

The approximate relative standard error for a percent p,

expressed as a percent of p, in which the numerator (N) and

the denominator (D) are estimates from the NHDS and the

numerator is a subclass of the denominator, can be computed

using the formula:

RSE(p = N/D) = 100 √(SEN

2 /N2

)–(SED

2 /D2

).

This formula can be used for percents based on data from all

years of the NHDS. For the 1988–92 data, the approximate

relative standard error for a percent p, expressed as a percent

of p, also can be calculated directly using the formula:

RSE(p) = 100√b(1–p) /(pX)

where 100p is the percent of interest, X is the denominator of

the percent, and b is the parameter b in the formula for

approximating the RSE(X). The values for b are given in

tables IX–XI.

These approximations are valid if the relative standard

error of the denominator is less than 5 percent or the relative

standard errors of the numerator and denominator are both less

than 10 percent (43,44).

Relative standard errors where the numerator is not

a subclass of the denominator

If the denominator of the rate is an estimate produced by

the U.S. Bureau of the Census for the total U.S. population or

Table VI. Approximate relative standard errors of estimated

number of discharges or first-listed diagnoses by size of

estimate: 1980 and 1985

Size of estimate 19801

1985

Region

All other

characteristics2

5,000 .................. 18.0 22.4 13.2

10,000 ................. 14.9 18.3 10.6

25,000 . . . . . . . . . . . . . . . . . 11.9 14.3 8.1

50,000 ................. 10.1 12.0 6.7

100,000 . . . . . . . . . . . . . . . . 8.8 10.3 5.7

250,000 . . . . . . . . . . . . . . . . 7.4 8.5 4.6

500,000 . . . . . . . . . . . . . . . . 6.5 7.5 4.0

1,000,000 . . . . . . . . . . . . . . . 5.8 6.6 3.5

3,000,000 . . . . . . . . . . . . . . . 5.0 5.6 2.9

5,000,000 . . . . . . . . . . . . . . . 4.7 5.2 2.7

10,000,000 . . . . . . . . . . . . . . 4.3 4.8 2.4

20,000,000 . . . . . . . . . . . . . . 4.0 4.4 2.2

30,000,000 . . . . . . . . . . . . . . 3.8 4.2 2.1

40,000,000 . . . . . . . . . . . . . . 3.7 4.1 2.1

1Applicable to all 1980 estimates of discharges or first-listed diagnoses shown in this report.

2Applicable to all 1985 estimates of discharges or first-listed diagnoses shown in this report

except regional estimates.

Table VII. Approximate relative standard errors of estimated

number of days of care by size of estimate: 1980 and 1985

Size of estimate 19801

1985

Region

All other

characteristics2

10,000 ........................ 24.7 35.4 16.9

30,000 ........................ 18.9 26.4 13.0

50,000 ........................ 16.8 23.2 11.6

100,000 ....................... 14.3 19.4 9.9

300,000 . . . . . . . . . . . . . . . . . . . . . . . 11.2 14.9 7.8

500,000 ....................... 10.1 13.2 7.1

1,000,000 . . . . . . . . . . . . . . . . . . . . . . 8.8 11.2 6.2

3,000,000 . . . . . . . . . . . . . . . . . . . . . . 7.1 8.8 5.0

5,000,000 . . . . . . . . . . . . . . . . . . . . . . 6.5 7.9 4.6

10,000,000 . . . . . . . . . . . . . . . . . . . . . 5.7 6.9 4.1

50,000,000 . . . . . . . . . . . . . . . . . . . . . 4.4 5.1 3.2

100,000,000 . . . . . . . . . . . . . . . . . . . . 4.0 4.5 2.9

250,000,000 . . . . . . . . . . . . . . . . . . . . 3.5 3.9 2.6

1Applicable to all 1980 estimates of days of care shown in this report.

2Applicable to all 1985 estimates of days of care shown in this report except regional

estimates.

Table VIII. Approximate relative standard errors of estimated

number of procedures by size of estimate: 1980 and 1985

Size of estimate

1980 1985

Region

All other

characteristics1 Region

All other

characteristics2

5,000 ........... 29.8 17.3 31.3 18.2

10,000 .......... 24.3 14.7 26.4 15.1

25,000 .......... 19.1 12.1 21.4 12.0

50,000 .......... 16.1 10.6 18.6 10.3

100,000 ......... 13.8 9.4 16.3 8.9

250,000 . . . . . . . . . 11.4 8.1 13.9 7.5

500,000 ......... 10.0 7.3 12.5 6.7

1,000,000 . . . . . . . . 8.9 6.7 11.3 6.0

3,000,000 . . . . . . . . 7.5 5.9 9.9 5.1

5,000,000 . . . . . . . . 7.0 5.6 9.3 4.8

10,000,000 . . . . . . . 6.4 5.2 8.7 4.4

20,000,000 . . . . . . . 5.9 4.9 8.1 4.1

30,000,000 . . . . . . . 5.7 4.7 7.8 4.0

1Applicable to all 1980 estimates of procedures shown in this report except regional

estimates.

2Applicable to all 1985 estimates of procedures shown in this report except regional

estimates.

63
one or more of the age and sex groups of the population, then

the approximate relative standard error of the rate is equivalent

to the approximate relative standard error of the numerator

that can be obtained from tables VI–XI.

If the numerator X and the denominator Y are both

estimated from the NHDS, then the approximate relative

standard error of the ratio X/Y, expressed as a percent of X/Y,

is calculated using the formula:

RSE(X/Y) = 100 √[RSE(X)]2+ [RSE(Y)]2

This approximation is valid if the relative standard error of the

denominator is less than 5 percent or the relative standard

errors of the numerator and denominator are both less than

10 percent (43,44).

Weighted least squares as a test for trend

A weighted least squares regression method has been used

to analyze data from the National Hospital Discharge Survey

(45). This method was adapted to analyze selected trends in

rates for the years 1988–92. Exact standard errors were

obtained for use in the weighted least squares test for trends.

These standard errors were computed using SUDAAN software, which uses a first-order Taylor series approximation of

the deviation of estimates from their expected values. The

SUDAAN software and the approach it uses is described in

the user’s manual (19).

If it is hypothesized that a linear relationship exists

between an independent variable and a dependent variable (for

Table IX. Estimated parameters for approximate relative standard error equations for number of discharges or first-listed diagnoses by

selected characteristics: 1988–92

Selected characteristic

1988 1989 1990 1991 1992

ababababa b

Total .................. 0.00358 173.173 0.00360 171.428 0.00213 228.834 0.00101 546.321 0.00097 449.059

Sex

Male .................. 0.00273 263.937 0.00271 348.880 0.00152 313.079 0.00447 213.042 0.00377 355.244

Female ................ 0.00214 355.406 0.00235 338.538 0.00125 311.632 0.00099 442.186 0.00089 404.530

Age

Under 15 years ........... 0.01984 109.886 0.02168 107.150 0.01597 47.116 0.01786 65.842 0.06075 81.775

15–44 years ............. 0.00312 158.564 0.00341 165.558 0.00142 299.762 0.00956 111.147 0.01291 44.505

45–64 years ............. 0.00361 139.812 0.00295 252.955 0.00157 234.543 0.01292 44.094 0.00656 147.706

65 years and over .......... 0.00262 248.331 0.00281 202.073 0.00161 263.223 0.01149 25.788 0.00175 464.831

Region

Northeast ............... 0.00432 154.474 0.00380 132.181 0.00274 56.268 0.00293 243.156 0.00275 277.031

Midwest ................ 0.01049 215.711 0.01126 252.898 0.00487 183.531 0.00603 331.780 0.00358 296.767

South ................. 0.00637 194.720 0.00588 175.845 0.00375 343.892 0.00247 547.686 0.00375 464.132

West . . . . . . . . . . . . . . . . . . 0.00858 221.258 0.01397 245.475 0.00564 318.914 0.00513 403.340 0.00006 1,168.044

NOTE: The approximate relative standard error (RSE) for an estimate (X) can be determined from the equation RSE(X) = 100 √a + b/x.

Table X. Estimated parameters for approximate relative standard error equations for number of days of care by selected characteristics:

1988–92

Selected characteristic

1988 1989 1990 1991 1992

a b a b aba b a b

Total .................. 0.00446 1,222.400 0.00404 1,438.643 0.00358 452.582 0.00173 2,343.213 0.00150 2,671.104

Sex

Male .................. 0.00331 1,554.308 0.00311 1,853.369 0.00293 292.127 0.00518 5,120.963 0.00823 995.275

Female ................ 0.00241 1,602.350 0.00253 1,907.568 0.00213 701.564 0.00194 1,634.957 0.00149 1,914.510

Age

Under 15 years ........... 0.01604 708.124 0.01976 1,248.390 0.00224 140.764 0.07618 737.582 0.12836 71.171

15–44 years ............. 0.00289 1,097.768 0.00298 1,225.181 0.00301 460.089 0.02384 475.352 0.02014 222.396

45–64 years ............. 0.00366 1,102.740 0.00278 1,551.060 0.00920 432.971 0.02949 92.219 0.01746 151.920

65 years and over .......... 0.00312 2,314.965 0.00295 2,110.341 0.00251 762.854 0.01849 25.558 0.01680 456.313

Region

Northeast ............... 0.00421 1,003.567 0.00432 972.782 0.00368 146.195 0.00451 1,967.234 0.00489 2,079.029

Midwest ................ 0.01152 1,086.414 0.01289 1,493.015 0.00605 970.001 0.01037 608.558 0.00557 1,297.946

South ................. 0.00733 1,722.863 0.00436 1,408.247 0.00540 929.232 0.00400 1,435.185 0.00457 1,148.825

West . . . . . . . . . . . . . . . . . . 0.01053 1,188.078 0.01456 1,361.642 0.01036 830.740 0.00891 871.769 0.02108 1,902.219

NOTE: The approximate relative standard error (RSE) for an estimate (X) can be determined from the equation RSE(X) = 100 √a + b/x.

64
example, year and discharge rate), then a useful test for this

relationship is to fit a regression line to the data, determine the

slope of the line, and then determine whether or not this slope

is significantly different from zero. That is, a regression line of

the form

Yi = a + bX i

is fitted to the data, where, for this example, Yi = predicted

discharge rate, Xi = year, a = the estimated Y –intercept, that is

the estimated discharge rate if year equals zero, and b = the

estimated slope of Y on X, that is, the estimated rate of change

in the discharge rate per unit change in year.

The data available from the National Hospital Discharge

Survey present certain basic problems that discourage the use

of classical regression procedures. Among these problems are

violation of the assumptions of independence of the original

observations, violation of homoscedasticity, that is, equal

variances of the dependent variable within each category of

the independent variable, perhaps violation of the normality

assumption, and so forth. Dr. Paul Levy, formerly of NCHS,

has devised a modified regression model that makes no

assumptions about the original observations and that makes no

stronger assumptions about the sample estimates than are

made in testing whether two means are equal when the

estimated means and their standard errors are obtained from

complex surveys (45,46).

The proposed model is as follows:

1. Let Yi be the estimate of interest and Syi be the estimated

standard error for the ith group.

2. Let Xi be the independent variable for the group.

3. Assume Syi is based on a large enough number of

observations that it can be assumed to be equal to

syi

and thus without sampling error.

4. Further assume that

E ( Yi ) = α + βXi

V ( Yi )= Syi

2 for i = 1, 2, . . . , K

where α is the true Y–intercept, β is the true slope, and K is the

number of groups.

5. Finally, assume that the Yi are normally distributed and

are statistically independent of each other.

The weighting procedure proposed weights all observations by the reciprocal of the variance. That is, wi = 1/ Syi

2 and

the mean X = Σ w i Xi /Σ wi and the mean Y = Σ wi Yi /Σ wi .

The slope is computed in a manner similar to the classical

least squares regression, by using the following formula:

b = Σwi (X i – X )Yi

Σwi (X i – X )

2

This is easily computed by using

b = Σwi

XiYi – (Σw i) (X) (Y)

Σwi Xi

2 – (Σwi

) X 2

The variance of the slope is

sb

2 = Σwi (Xi – X)2

σy

2

[Σwi (Xi – X)

2

]

2

Because wi= 1/ σyi

2 , this formula can be simplified to

σb

2 = Σwi (X i – X)

2

[Σwi (X i – X)

2

]

2 = 1

Σwi (Xi–X)

2

and computationally

Table XI. Estimated parameters for approximate relative standard error equations for number of procedures by selected characteristics:

1988–92

Selected characteristic

1988 1989 1990 1991 1992

ababababab

Total .................. 0.00415 464.814 0.00440 477.756 0.00547 92.597 0.00153 427.265 0.00143 377.158

Sex

Male .................. 0.00376 428.402 0.00388 444.732 0.00410 89.724 0.00568 139.827 0.00465 336.276

Female ................ 0.00332 467.482 0.00373 457.376 0.00337 83.021 0.00164 342.466 0.00124 416.841

Age

Under 15 years ........... 0.02228 428.541 0.02644 386.539 0.03171 44.124 0.03313 53.065 0.10248 74.715

15–44 years ............. 0.00362 443.165 0.00376 445.183 0.00302 139.070 0.00986 87.726 0.00903 153.675

45–64 years ............. 0.00374 463.928 0.00376 483.766 0.00491 68.024 0.01182 125.847 0.00494 295.564

65 years and over .......... 0.00351 442.050 0.00383 468.438 0.00436 47.886 0.01629 12.837 0.00986 288.155

Region

Northeast ............... 0.00493 285.834 0.00456 331.430 0.00588 108.765 0.00746 181.945 0.00556 166.484

Midwest ................ 0.01138 464.393 0.01426 491.416 0.00886 107.681 0.00781 333.914 0.00587 240.949

South ................. 0.00833 449.500 0.00854 452.325 0.00781 50.919 0.00298 468.737 0.00298 430.632

West . . . . . . . . . . . . . . . . . . 0.01193 571.693 0.01387 541.125 0.01235 144.582 0.00753 251.058 0.00831 735.033

NOTE: The approximate relative standard error (RSE) for an estimate (X) can be determined from the equation RSE(X) = 100 = a + b/x.

65
Sb=Œ 1

Σwi Xi

2

– (Σwi) X 2

For the weighted least squares test, the null hypothesis is

that the slope of the regression line does not significantly

differ from zero, and the alternate hypothesis is that it does

differ from zero (i.e., H0:β=0, and HA:β≠0). An approximate

normal deviate test of the null hypothesis can be performed by

computing z = b/Sb and comparing the absolute value of the

result to the appropriate critical value.

For example, the discharge rate (Y) by year (X) is

recorded as shown in table XII. Exact standard errors, computed using SUDAAN software are shown in table XII. These

may not agree with approximate standard errors calculated

from tables IX–XI. By applying the method described to the

data shown, we have:

Sw i X i Y i = 96,721.547

Sw i = 0.390

Sw i X i = 776.196

Sw i

Y i = 48.598

Sw i X i

2 = 1,544,821.826

X = 1,990.246

Y = 124.611

b = –1.429

S b = 1.177

z = –1.215

Because the z value is less than the critical value

(z1.215z<1.96), no association between the discharge rate

and year is demonstrated.

Tests of significance

In this report, the statistical significance of the weighted

least squares test for trends is based on the two-sided z-test

with a critical value of 1.96 (0.05 level of significance). The

determination of statistical inference for the testing of differences between rates in table V is based on the two-sided t-test

with a critical value of 1.96 (0.05 level of significance). Terms

such as ‘‘higher’’ and ‘‘less’’ that relate to differences are

statistically significant. Terms such as ‘‘similar’’ or ‘‘no difference’’ mean that no statistically significant difference exists

between the estimates being compared. A lack of comment on

the difference between any two estimates does not mean that

the difference was tested and found not significant.

Table XII. Worksheet for weighted least squares regression of

discharge rate on year: United States, 1988–92

Year (Xi )

Discharge rate

per 1,000

population (Yi )

Standard error

of discharge

rate (Syi) wi = 1/Syi

2

1988 ............. 128.3 4.093 0.060

1989 ............. 126.2 4.329 0.053

1990 ............. 124.3 3.170 0.100

1991 ............. 124.1 3.426 0.085

1992 ............. 122.1 3.301 0.092

66
Appendix II

Definitions of terms

Terms relating to hospitalization

Hospitals—Hospitals with an average length of stay of

less than 30 days for all patients. For 1988–92, hospitals

whose specialty was general (medical or surgical) or children’s general were also included, even if the average length

of stay for all patients was 30 days or more. Federal hospitals,

hospital units of institutions, and hospitals with less than six

beds staffed for patients’ use are not included.

Inpatient—A person who is formally admitted to the

inpatient service of a short-stay hospital for observation, care,

diagnosis, or treatment. The terms ‘‘inpatient’’ and ‘‘patient’’

are used synonymously.

Newborn infant—A patient admitted by birth to a hospital.

Discharge—The formal release of a patient by a hospital;

that is, the termination of a period of hospitalization by death

or by disposition to place of residence, nursing home, or

another hospital. The terms ‘‘discharges’’ and ‘‘patients discharged’’ are used synonymously.

Discharge rate—The ratio of the number of hospital

discharges during a year to the number of persons in the

civilian population on July 1 of that year.

Days of care—The number of patient days accumulated at

the time of discharge by a patient. A stay of less than 1 day

(patient admission and discharge on the same day) is counted

as 1 day in the summation of total days of care. For patients

admitted and discharged on different days, the number of days

of care is computed by counting all days from (and including)

the date of admission to (but not including) the date of

discharge.

Rate of days of care—The ratio of the number of days of

care accumulated during a year to the number of persons in the

civilian population on July 1 of that year.

Average length of stay—The number of days of care

accumulated by patients discharged during the year divided by

the number of these discharges.

Fatality rate—The ratio of the number of hospital deaths

to the number of discharges, multiplied by 100.

Terms relating to diagnoses

Diagnosis—A disease or injury (or factor that influences

health status and contact with health services that is not itself a

current illness or injury) listed on the medical record of a patient.

Principal diagnosis—The condition established after study

to be chiefly responsible for occasioning the admission of the

patient to the hospital for care.

First-listed diagnosis—The diagnosis specified as the

principal diagnosis on the face sheet or discharge summary of

the medical record, or if the principal diagnosis is not specified, the diagnosis listed first on the face sheet or discharge

summary of the medical record (see the ‘‘Medical coding and

edit’’ section of appendix I). The number of first-listed diagnoses is equivalent to the number of discharges.

Terms relating to procedures

Discharges with procedures—The estimated number of

patients discharged from non-Federal short-stay hospitals during the year who underwent at least one procedure during their

hospitalization.

Procedure—A surgical or nonsurgical operation, diagnostic procedure, or special treatment reported on the medical

record of a patient. (See the ‘‘Medical coding and edit’’ section

of appendix I for further details.)

Procedures have been categorized into four classes according to UHDDS guidelines (47). Classes 1–3 consist of procedures that carry an operative or anesthetic risk or require

highly trained personnel, special facilities, or special equipment. Class 4 procedures do not meet these criteria, and

reporting class 4 procedures was optional in 1979. Only three

class 4 procedures were coded for the NHDS from 1979 until

1983. The decision was made to code additional class 4

procedures in 1983, and the number coded was further expanded

in 1989. Beginning with the 1991 data, all ICD–9–CM

procedure codes have been used for the NHDS. Table XIII

shows the code numbers for class 4 procedures and the year

each code was first used in the NHDS.

All-listed procedures—All occurrences of a procedure on

medical record, regardless of the order. In the NHDS a

maximum of four procedures are coded for each discharge.

Surgical procedures—All procedures except those shown

in table XIV are considered surgical procedures.

Nonsurgical procedures—Procedures generally not

regarded as surgical, including diagnostic endoscopy and

radiotherapy, physical medicine and rehabilitation, and other

diagnostic and therapeutic procedures. The ICD–9–CM codes

classified as nonsurgical procedures for the NHDS are shown

in table XIV. The classification of procedures as surgical or

nonsurgical was revised beginning with the 1989 data. Many

of the procedures added to the nonsurgical category were class

4 procedures that had not been coded until 1983 or 1989. All

obstetrical procedures were classified as surgical until 1989.

67
Rate of procedures—The ratio of the number of procedures during a year to the number of persons in the civilian

population on July 1 of that year determines the rate of

procedures.

Demographic terms

Population—The U.S. resident population excluding members of the Armed Forces.

Age—Patient’s age at birthday prior to admission to the

hospital.

Age adjustment—Age adjustment, using the direct method,

is the application of the age-specific rates in a population of

interest to a standardized age distribution in order to eliminate

the differences in observed rates that result from age differences in population composition. In this report, rates of

discharges and days of care are age adjusted to the U.S.

standard million population (relative age distribution of the

1980 civilian population totaling 1,000,000) (table XV). Adjustment is based on four age groups. Adjusted average lengths of

stay were computed by dividing adjusted days of care by

adjusted discharges.

Geographic region—Hospitals are classified by location

in one of the four geographic regions of the United States that

correspond to those used by the U.S. Bureau of the Census.

Region States included

Northeast Maine, New Hampshire, Vermont,

Massachusetts, Rhode Island,

Connecticut, New York, New Jersey,

and Pennsylvania

Midwest Michigan, Ohio, Illinois, Indiana,

Wisconsin, Minnesota, Iowa,

Missouri, North Dakota, South

Dakota, Nebraska, and Kansas

South Delaware, Maryland, District of

Columbia, Virginia, West Virginia,

North Carolina, South Carolina,

Georgia, Florida, Kentucky,

Tennessee, Alabama, Mississippi,

Arkansas, Louisiana, Oklahoma, and

Texas

West Montana, Idaho, Wyoming, Colorado,

New Mexico, Arizona, Utah, Nevada,

Washington, Oregon, California,

Hawaii, and Alaska

Table XIII. Code numbers for class 4 procedures and year first used to code data from the National Hospital Discharge Survey

[Code numbers are from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Procedure

code

First

used

Procedure

code

First

used

Procedure

code

First

used

Procedure

code

First

used

01.18–01.19 ...... 1983 38.29............. 1983 71.19............. 1983 89.66............. 1989

03.39 ........... 1983 40.19............. 1983 73.6 ............. 1979 89.7 ............. 1991

04.19 ........... 1983 41.38–41.39 ........ 1989 73.91–73.92 ........ 1989 90.01–91.99 ........ 1991

05.19 ........... 1983 42.29............. 1989 75.35............. 1989 93.01–93.25 ........ 1991

06.19 ........... 1983 44.91............. 1989 76.19............. 1983 93.27–93.28 ........ 1991

07.19 ........... 1983 45.19............. 1989 78.80–78.89 ........ 1983 93.31–93.39 ........ 1991

08.19 ........... 1989 45.28–45.29 ........ 1989 81.98............. 1983 93.42–93.44 ........ 1989

08.91–08.93 ...... 1983 48.23............. 1989 83.29............. 1983 93.61–93.89 ........ 1991

09.19 ........... 1983 48.29............. 1989 85.19............. 1989 93.91............. 1991

09.41–09.49 ...... 1983 49.21............. 1989 86.19............. 1989 93.94............. 1989

10.29 ........... 1983 49.29............. 1989 86.92............. 1989 93.96............. 1989

11.29 ........... 1983 49.41............. 1989 87.09–87.12 ........ 1991 93.99............. 1989

12.29 ........... 1983 50.19............. 1983 87.16–87.17 ........ 1991 94.01–94.23 ........ 1991

14.19 ........... 1983 51.19............. 1983 87.22–87.29 ........ 1991 94.25............. 1991

15.09 ........... 1983 52.19............. 1983 87.36–87.37 ........ 1989 94.29–94.59 ........ 1991

16.21 ........... 1989 54.29............. 1983 87.39............. 1991 95.01–95.03 ........ 1991

16.29 ........... 1983 55.29............. 1983 87.43–87.49 ........ 1991 95.05–95.11 ........ 1991

18.01 ........... 1989 56.39............. 1983 87.69............. 1989 95.14–95.15 ........ 1991

18.11 ........... 1989 57.39............. 1983 87.79............. 1989 95.31–95.48 ........ 1991

18.19 ........... 1989 58.29............. 1989 87.85–87.89 ........ 1991 95.49............. 1989

20.39 ........... 1983 59.29............. 1983 87.92............. 1991 96.09............. 1989

21.21 ........... 1989 60.18............. 1983 87.95–87.99 ........ 1991 96.11–96.19 ........ 1991

21.29 ........... 1989 61.19............. 1989 88.09............. 1991 96.26–96.28 ........ 1991

22.19 ........... 1989 62.19............. 1983 88.16–88.31 ........ 1991 96.34–96.59 ........ 1991

24.19 ........... 1989 63.09............. 1983 88.33............. 1991 97.01–97.04 ........ 1991

25.09 ........... 1989 64.0 ............. 1979 88.35............. 1991 97.14–97.69 ........ 1991

25.91 ........... 1989 64.19............. 1989 88.37............. 1991 97.71............. 1979

26.19 ........... 1989 64.91............. 1989 88.39............. 1991 97.72–97.89 ........ 1991

27.29 ........... 1989 64.94............. 1989 89.01–89.09 ........ 1991 99.02–99.14 ........ 1991

27.91 ........... 1989 65.19............. 1983 89.11–89.13 ........ 1991 99.16–99.24 ........ 1991

28.19 ........... 1983 66.19............. 1983 89.15–89.16 ........ 1991 99.26–99.59 ........ 1991

29.19 ........... 1989 67.19............. 1983 89.26–89.31 ........ 1991 99.71–99.79 ........ 1989

31.48–31.49 ...... 1989 68.19............. 1983 89.33–89.39 ........ 1991 99.82–99.84 ........ 1990

33.28–33.29 ...... 1983 69.92............. 1989 89.45–89.49 ........ 1989 99.91–99.99 ........ 1990

34.28–34.29 ...... 1983 70.21............. 1989 89.51–89.53 ........ 1989

37.29 ........... 1989 70.29............. 1983 89.55–89.59 ........ 1989

68
Table XIV. Code numbers for procedures considered nonsurgical in the National Hospital Discharge Survey by chapter and year

[Code numbers and chapters are based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Procedure chapter and ICD–9–CM code 1979–88 1989–92

Nonsurgical codes

Operations on the nervous system ................................. 01–05 03.31 01.18–01.19,03.31,03.39,

04.19,05.19

Operations on the endocrine system ................................ 06–07 06.19, 07.19

Operations on the eye ......................................... 08–16 11.21,12.21,14.11,16.22 08.19,09.19,09.41–09.49,

10.29,11.29,12.29,14.19,

15.09,16.21,16.29

Operations on the ear ......................................... 18–20 20.31 18.01,18.11,18.19,20.31,

20.39

Operations on the nose, mouth, and pharynx ........................... 21–29 29.11 21.00–21.02,21.21,21.29,

22.19,24.19,25.09,26.19,

27.29,28.19,29.11,29.19

Operations on the respiratory system ................................ 30–34 31.41–31.42,33.21–33.23 31.41–31.42,31.48–31.49,

34.21–34.22 33.21–33.23,33.29,

34.21–34.22,34.28–34.29

Operations on the cardiovascular system ............................. 35–39 39.95 37.26–37.27,37.29,38.29,39.95

Operations on the hemic and lymphatic system ......................... 40–41 40.19,41.38–41.39

Operations on the digestive system ................................. 42–54 42.21–42.23,44.11–44.13, 42.22–42.23,42.29,

45.11–45.13,45.21–45.24, 44.11–44.13,44.19,

48.21–48.22,51.11,54.21 45.11–45.13,45.19,

45.21–45.24,45.28–45.29,

48.21–48.23,48.29,

49.21,49.29,50.19,

51.10–51.11,51.19,52.19,

54.21,54.29

Operations on the urinary system .................................. 55–59 55.21–55.22,56.31, 55.21–55.22,55.29,56.31,

57.31–57.32,58.21–58.22 56.35,56.39,57.31–57.32,

57.39,57.94–57.95,

58.21–58.22,58.29,59.29

Operations on the male genital organs ............................... 60–64 60.19 60.18–60.19,61.19,62.19,

63.09,64.19,64.94

Operations on the female genital organs .............................. 65–71 68.11–68.12,70.22 65.19,66.19,67.19,68.11,

68.19,69.92,70.21–70.22,

70.29,71.19

Obstetrical procedures ......................................... 72–75 73.4,73.51–73.59,

73.91–73.92,75.31–75.32,

75.34–75.35,75.94

Operations on the musculoskeletal system ............................ 76–84 80.20–80.29 76.19,78.80–78.89,

80.20–80.29,81.98,83.29,

84.41–84.43,84.45–84.47

Operations on the integumentary system .............................. 85–86 85.19,86.19,86.92

Miscellaneous diagnostic and therapeutic procedures ...................... 87–99 87.01–99.99 87.01–99.99

Table XV. Standard million age distribution used to adjust rates

to the U.S. civilian population on July 1, 1980

[Based on population estimates consistent with Series P-25, Current Population

Reports, U.S. Bureau of the Census]

Age

Standard

million

All ages ............................ 1,000,000

Under 15 years ....................... 227,328

15–44 years ......................... 461,653

45–64 years ......................... 197,078

65 years and over ...................... 113,941

69
Appendix III

Recent publications from the

National Hospital Discharge

Survey

Data from the National Hospital Discharge Survey are

presented each year in a variety of publications of the National

Center for Health Statistics (NCHS). The following table

shows recent NCHS publications. For a list of NCHS

publications that contain 1965–86 data from the National

Hospital Discharge Survey, see Trends in hospital utilization,

United States, 1965–86.

Year(s)

of data Title Series

1965–86 Trends in hospital utilization, United States, 1965–86 Vital and Health Statistics

Series 13, No. 101

1987 1987 summary: National Hospital Discharge Survey Advance Data From Vital and

Health Statistics, No. 159(rev)

National Hospital Discharge Survey: annual

summary, 1987

Vital and Health Statistics

Series 13, No. 99

Detailed diagnoses and procedures, National

Hospital Discharge Survey, 1987

Vital and Health Statistics

Series 13, No. 100

1983–87 Hospital inpatient surgery: United States,1983–87 Advance Data From Vital and

Health Statistics, No. 169

1988 1988 summary: National Hospital Discharge Survey Advance Data From Vital and

Health Statistics, No. 185

National Hospital Discharge Survey: annual

summary, 1988

Vital and Health Statistics

Series 13, No. 106

Detailed diagnoses and procedures, National

Hospital Discharge Survey, 1988

Vital and Health Statistics

Series 13, No. 107

Estimates from two survey designs: National Hospital

Discharge Survey

Vital and Health Statistics

Series 13, No. 111

1989 1989 summary: National Hospital Discharge Survey Advance Data From Vital and

Health Statistics, No. 199

Detailed diagnoses and procedures, National

Hospital Discharge Survey, 1989

Vital and Health Statistics

Series 13, No. 108

National Hospital Discharge Survey: annual

summary, 1989

Vital and Health Statistics

Series 13, No. 109

1990 1990 summary: National Hospital Discharge Survey Advance Data From Vital and

Health Statistics, No. 210

National Hospital Discharge Survey: annual

summary, 1990

Vital and Health Statistics

Series 13, No. 112

Detailed diagnoses and procedures, National

Hospital Discharge Survey, 1990

Vital and Health Statistics

Series 13, No. 113

Expected principal source of payment for hospital

discharges: United States, 1990

Advance Data From Vital and

Health Statistics, No. 220

70
Year(s)

of data Title Series

1980–90 Long-stay patients in short-stay hospitals Advance Data From Vital and

Health Statistics, No. 229

1991 1991 summary: National Hospital Discharge Survey Advance Data From Vital and

Health Statistics, No. 227

National Hospital Discharge Survey: annual

summary, 1991

Vital and Health Statistics

Series 13, No. 114

Detailed diagnoses and procedures, National

Hospital Discharge Survey, 1991

Vital and Health Statistics

Series 13, No. 115

Hospitalizations for injury and poisoning in the United States,

1991

Advance Data From Vital and

Health Statistics, No. 252

1992 1992 summary: National Hospital Discharge Survey Advance Data From Vital and

Health Statistics, No. 249

Detailed diagnoses and procedures, National

Hospital Discharge Survey, 1992

Vital and Health Statistics

Series 13, No. 118

National Hospital Discharge Survey: annual

summary, 1992

Vital and Health Statistics

Series 13, No. 119

1990–92 Underreporting of race in the National Hospital

Discharge Survey

Advance Data From Vital and

Health Statistics, No. 265

71
DHHS Publication No. (PHS) 96-1782, Series 13, No. 124

6-0308 (6/96)

COVER 4

PRINTE

PRINTER:

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NEGATIVE ART FOR FRONT COVER (cover 1): PRINT SOLID PMS