Ambulatory Surgery in the United States, 1995

by Margaret Jean Hall and Linda Lawrence, Division of Health Care Statistics

Highlights

Ambulatory surgery visits

+ In 1995, an estimated 29.4 million

surgical and nonsurgical procedures

were performed during 19.6 million

ambulatory surgery visits (table 1).

+ The 19.6 million ambulatory surgery

visits accounted for half of the

combined total of ambulatory surgery

visits and inpatient discharges with

surgical and nonsurgical procedures

(38.9 million) (figure 1).

+ An estimated 16.4 million (84

percent) of the ambulatory surgery

visits occurred in hospitals and 3.2

million (16 percent) occurred in

freestanding centers (table 2, figure

2).

+ Females had significantly more

ambulatory surgery visits (11.1

million) than males (8.5 million), and

a significantly higher rate of visits

(82.8 per 1,000 population) compared

with males (67.1 per 1,000

population) (table 3).

+ The rate of ambulatory surgery visits

per 1,000 population was higher for

males (33.6) than for females (25.4)

under 15 years of age and higher for

females than for males for the 15–44

age group (62.7 versus 39.2).

However, there was no significant

difference in the rates for males and

females for the age groups 45–64

years old (110.2 versus 96.8) and 65

years of age and over (204.2 versus

186.9) (figure 3).

Ambulatory procedures

+ Four procedures were each performed

more than a million times on

ambulatory patients: extraction of

lens (2,275,000), endoscopy of large

intestine (1,809,000), insertion of

prosthetic lens (1,723,000), and

endoscopy of small intestine

(1,490,000) (table 4, figure 4).

+ Females had higher rates per 10,000

population than males for ambulatory

Abstract

Objectives—This report presents estimates of surgical and nonsurgical

procedures performed on an ambulatory basis in hospitals and freestanding

ambulatory surgery centers in the United States during 1995. Data are presented by

types of facilities, age, sex, and geographic region. Major categories of procedures

and diagnoses are shown by age, sex, and region.

Methods—The estimates are based on data collected from the 1995 National

Survey of Ambulatory Surgery conducted by the National Center for Health

Statistics. The 1995 data were abstracted from 122,000 medical records in 489

hospitals and freestanding ambulatory surgery centers.

Keywords: National Survey of Ambulatory Surgery c procedures c diagnoses c

outpatients

Acknowledgments

This report was prepared in the Division of Health Care Statistics. The staff of the Hospital Care Statistics Branch processed the data and assisted

in developing the report. Maria Owings produced the standard errors. Iris Shimizu, Office of Research and Methodology, assisted with estimation

and variances. Computer programming was done by Rong Cai, Flora Lan, and David Lei under contract with the OAO Corporation. Fieldwork and

data collection activities were completed under a contractual agreement with the U.S. Bureau of the Census. The report was edited by Klaudia Cox

and typeset by Annette F. Holman of the Publications Branch, Division of Data Services.

Number 296 + December 24, 1997

From Vital and Health Statistics of the CENTERS FOR DISEASE CONTROLAND PREVENTION/National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics CENTERS FOR DISEASE CONTROL

AND PREVENTION
procedures such as release of carpal

tunnel (15.4 versus 9.2), operations

on eyelids (9.5 versus 6.9), extraction

(107.9 versus 65.0) and insertion of

lens (80.9 versus 50.1), endoscopy of

small intestine (63.8 versus 49.8),

laparoscopy (27.7 versus 2.9),

laparoscopic cholecystectomy (14.1

versus 3.9), and excision and repair

of bunion and other toe deformity

(14.6 versus 4.2) (tables 5 and 6).

+ Males had higher rates per 10,000

population than females for

ambulatory procedures such as

myringotomy with insertion of tube

(25.6 versus 17.3), adenoidectomy

without tonsillectomy (6.7 versus

4.3), cardiac catheterization (15.7

versus 9.0), repair of inguinal hernia

(33.8 versus 4.3), cystoscopy (34.8

versus 21.1), reduction of fracture

(9.2 versus 6.4), arthroscopy of knee

(29.6 versus 19.3), excision of

semilunar cartilage of knee (22.4

versus 13.0); replacement or other

repair of knee (11.1 versus 8.0), and

arteriography and angiocardiography

using contrast material (25.6 versus

14.8).

+ Ambulatory procedures performed

more than 100,000 times on children

under 15 years old included

myringotomy (521,000),

tonsillectomy (279,000),

adenoidectomy without tonsillectomy

(136,000), and operations on teeth,

gums, and alveoli (165,000).

+ A variety of ambulatory procedures

were performed more than 300,000

times on persons 15–44 years of age:

endoscopy of small intestine

(388,000), arthroscopy of knee

(357,000), bilateral destruction or

occlusion of fallopian tubes

(354,000), laparoscopy (341,000),

dilation and curettage of uterus

(321,000), endoscopy of large

Table 1. Number and rate of visits or discharges and procedures by type of patient: United States, 1995

[Excludes ambulatory surgery patients admitted to hospitals as inpatients]

Utilization measure

Total Ambulatory1 Inpatient2

Estimate

Standard

error Estimate

Standard

error Estimate

Standard

error

Number of visits or discharges in thousands3 ..... 38,888 1,107 19,638 873 19,250 680

Rate of visits or discharges per 1,000 population3 . . 148.8 4.2 75.1 3.3 73.6 2.6

Number of procedures in thousands ........... 69,240 2,040 29,433 1,275 39,807 1,592

Rate of procedures per 1,000 population ........ 264.9 7.8 112.6 4.9 152.3 6.1

1

Data from the 1995 National Survey of Ambulatory Surgery.

2

Data from the 1995 National Hospital Discharge Survey.

3

Ambulatory surgery visits or discharges of hospital inpatients with procedures.

Figure 1. Utilization measures for ambulatory surgery visits and discharges of hospital

inpatients with procedures: United States, 1995

Table 2. Number and rate of ambulatory surgery visits and procedures by type of facility: United States, 1995

[Excludes ambulatory surgery patients admitted to hospitals as inpatients]

Utilization measure

All facilities Hospitals Freestanding centers

Estimate

Standard

error Estimate

Standard

error Estimate

Standard

error

Number of visits in thousands .......... 19,638 873 16,413 813 3,225 265

Rate of visits per 1,000 population ....... 75.1 3.3 62.8 3.1 12.3 1.0

Number of procedures in thousands ...... 29,433 1,275 24,562 1,191 4,871 382

Rate of procedures per 1,000 population . . . 112.6 4.9 94.0 4.6 18.6 1.5

2 Advance Data No. 296 + December 24, 1997
intestine (320,000), and excision or

destruction of lesion or tissue of skin

and subcutaneous tissue (313,000).

+ For persons 45–64 years of age,

endoscopy of large intestine

(682,000) and endoscopy of small

intestine (503,000) were frequent

ambulatory procedures.

+ Common ambulatory procedures for

persons 65 years of age and over

were extraction of lens (1,919,000),

insertion of prosthetic lens

(1,440,000), endoscopy of large

intestine (799,000), and endoscopy of

small intestine (575,000).

Diagnoses for ambulatory surgery

visits

+ Diagnoses for 500,000 or more

ambulatory surgery visits included

cataract (2,242,000); malignant

neoplasms (738,000); benign

neoplasms (960,000), especially

benign neoplasm of colon (572,000);

rheumatism (634,000); and otitis

media and Eustachian tube disorders

(528,000) (table 7).

+ Rates of ambulatory surgery visits per

10,000 population were higher for

females than for males for first-listed

diagnoses of carpal tunnel syndrome

(15.2 versus 8.9), glaucoma (5.0

versus 3.3), cataract (106.6 versus

63.8), gastritis and duodenitis (17.0

versus 10.3), diverticula of intestine

(14.8 versus 10.0), cholelithiasis (12.7

versus 3.4), acquired deformities of

toe (8.0 versus 2.4), abdominal pain

(10.9 versus 6.3), and visit for

sterilization (24.3 versus 4.6) (tables

8 and 9).

+ Rates of ambulatory surgery visits per

10,000 population were higher for

males than for females for first-listed

diagnoses of otitis media and

Eustachian tube disorders (23.9

versus 16.7), heart disease (14.4

versus 8.1), deviated nasal septum

(6.0 versus 4.1), inguinal hernia (32.5

versus 4.2), calculus of kidney and

ureter (9.8 versus 5.1), hematuria (4.2

versus 2.7), fractures (13.2 versus

7.8), and current tear of medial

cartilage or meniscus of knee (12.7

versus 6.2).

Introduction

This report presents data from the

1995 National Survey of Ambulatory

Surgery (NSAS), which was initiated by

the National Center for Health Statistics

in 1994 to gather and disseminate data

about ambulatory surgery. For NSAS,

ambulatory surgery refers to surgical

and nonsurgical procedures performed

on an ambulatory (or outpatient) basis in

a hospital or freestanding center’s

general operating rooms, dedicated

ambulatory surgery rooms, and other

specialized rooms such as endoscopy

units and cardiac catheterization labs.

Ambulatory surgery has been

increasing in the United States since the

early 1980’s. Two major reasons for the

increase are advances in medical

technology and cost containment

initiatives. The medical advances

include improvements in anesthesia,

which enable patients to regain

consciousness more quickly with fewer

aftereffects, and better analgesics for

relief of pain. In addition, minimally

invasive and noninvasive procedures are

being developed and performed with

increasing frequency. Examples include

laser surgery, laparoscopy, and

endoscopy. These medical advances

have made surgery less complex and

risky (1).

At the same time, concern about

rising health care costs led to changes in

the Medicare program that encouraged

the development of ambulatory surgery.

In the early 1980’s, the Medicare

program was expanded to cover care in

ambulatory surgery centers, and a

prospective payment system based on

diagnosis-related groups (DRG’s) was

adopted for hospital inpatient care that

created strong financial incentives for

hospitals to shift less complex surgery

to outpatient settings. Many State

Medicaid plans and private insurers

followed the lead of the Medicare

program and adopted similar policies

(2).

As these changes went into effect,

many types of surgeries done in

Figure 2. Percent distribution of ambulatory surgery visits by type of facility:

United States, 1995

Advance Data No. 296 + December 24, 1997 3
hospitals increasingly were performed

during ambulatory visits. In addition, the

number of freestanding ambulatory

surgery centers grew from 239 in 1983

(3) to more than 1,800 in 1993 (4).

The National Hospital Discharge

Survey (NHDS), which has been

conducted by the National Center for

Health Statistics every year since 1965,

includes information on surgical and

nonsurgical procedures performed in

inpatient settings (5). Although NHDS

remains a good source of data for

procedures that can only be done on an

inpatient basis, such as open-heart

surgery or cesarean section, NHDS

estimates have become incomplete for

procedures that can be performed on an

ambulatory basis. NSAS was undertaken

to obtain information about ambulatory

procedures. For many types of

procedures, data from both NHDS and

NSAS are now required to obtain

national estimates. A report that

combines the 1994 procedure data from

the two surveys has been published (6).

Information on ambulatory

procedures is also collected in two other

NCHS surveys. The National

Ambulatory Medical Care Survey

obtains information on procedures

ordered or performed during visits to

physicians’ offices (7), and the National

Hospital Ambulatory Medical Care

Survey collects data on procedures

ordered or performed during visits to

hospital outpatient and emergency

departments (8,9).

This report provides summary data

from the 1995 NSAS. For perspective,

the NSAS data on ambulatory

procedures in 1995 are compared with

estimates of inpatient procedures from

the 1995 NHDS (5) in table 1. Estimates

from the NSAS are presented for

hospitals and freestanding facilities in

table 2 and by age, sex, and geographic

region in table 3. The types of

procedures performed during these visits

(tables 4–6) and diagnoses (tables 7–9)

are also shown.

Methods

Source of data

Following a feasibility study in

1989–91 and a pretest in 1993, NSAS

was conducted for the first time in 1994.

Results for 1994 have been published

(10). This survey covers surgical and

nonsurgical procedures performed on an

ambulatory basis in hospitals and

freestanding ambulatory surgery centers.

The hospital universe includes

noninstitutional hospitals exclusive of

Federal, military, and Department of

Veterans Affairs hospitals, located in the

50 States and the District of Columbia.

Only short-stay hospitals (hospitals with

an average length of stay for all patients

of fewer than 30 days) or those whose

specialty is general (medical or surgical)

or children’s general are included in the

survey. These hospitals must also have

six beds or more staffed for patient use.

The universe definition is the same as

that used for the National Hospital

Discharge Survey (5). The sampling

frame for the hospital universe consists

of eligible hospitals listed in the 1993

SMG Hospital Market Database (11).

Table 3. Number, percent distribution, and rate of ambulatory surgery visits by sex, age,

and region: United States, 1995

[Excludes ambulatory surgery patients admitted to hospitals as inpatients]

Age and region

Both sexes Male Female

Estimate

Standard

error Estimate

Standard

error Estimate

Standard

error

Number in thousands

Total.......................... 19,638 873 8,527 374 11,111 510

Age

Under 15 years ................... 1,708 88 993 51 715 41

15–44 years ..................... 6,015 290 2,299 108 3,716 191

45–64 years ..................... 5,410 292 2,438 135 2,972 163

65 years and over ................. 6,505 322 2,796 134 3,709 195

Region

Northeast ...................... 4,446 386 1,957 179 2,489 214

Midwest ....................... 4,914 348 2,117 162 2,797 192

South ......................... 6,638 635 2,787 249 3,851 388

West . . . . . . . . . . . . . . . . . . . . . . . . . 3,641 298 1,667 140 1,974 164

Percent distribution

Total.......................... 100.0 . . . 100.0 . . . 100.0 . . .

Age

Under 15 years . . . . . . . . . . . . . . . . . . . 8.7 0.4 11.6 0.6 6.4 0.4

15–44 years ..................... 30.6 1.5 27.0 1.3 33.4 1.7

45–64 years ..................... 27.6 1.5 28.6 1.6 26.7 1.5

65 years and over ................. 33.1 1.6 32.8 1.6 33.4 1.8

Region

Northeast ...................... 22.6 2.0 22.9 2.1 22.4 1.9

Midwest ....................... 25.0 1.8 24.8 1.9 25.2 1.7

South ......................... 33.8 3.2 32.7 2.9 34.7 3.5

West . . . . . . . . . . . . . . . . . . . . . . . . . 18.5 1.5 19.5 1.6 17.8 1.5

Rate per 1,000 population

Total.......................... 75.1 3.3 67.1 2.9 82.8 3.8

Age

Under 15 years ................... 29.6 1.5 33.6 1.7 25.4 1.4

15–44 years ..................... 51.0 2.5 39.2 1.8 62.7 3.2

45–64 years ..................... 103.7 5.6 96.8 5.4 110.2 6.1

65 years and over ................. 194.0 9.6 204.2 9.8 186.9 9.8

Region

Northeast ...................... 86.5 7.5 79.0 7.2 93.4 8.0

Midwest ....................... 79.6 5.6 70.5 5.4 88.3 6.0

South ......................... 72.8 7.0 63.3 5.7 81.7 8.2

West . . . . . . . . . . . . . . . . . . . . . . . . . 63.7 5.2 58.8 4.9 68.5 5.7

. . . Category not applicable.

4 Advance Data No. 296 + December 24, 1997
The universe of freestanding

facilities includes the freestanding

ambulatory surgery centers listed in the

1993 SMG Freestanding Outpatient

Surgery Center Database (12) and/or

Medicare-certified facilities included in

the Health Care Financing

Administration Provider-of-Services file

(13). Facilities specializing in dentistry,

podiatry, pain block, abortion, family

planning, or birthing are excluded. A

detailed description of the development

and operation of NSAS has been

published (14).

Sample design

NSAS uses a multistage probability

design with independent samples of

hospitals and freestanding ambulatory

surgery centers selected at the first or

second stages and visits to these

facilities selected at the final stage. The

NSAS sample includes all facilities with

a high annual volume of ambulatory

procedures. The remaining sample of

facilities is selected using a three-stage

stratified cluster design.

The first stage consists of a

selection of a subsample of the primary

sampling units (PSU’s) used in the

1985–94 National Health Interview

Survey (15). PSU’s are counties, a

group of counties, county equivalents

(such as parishes or independent cities),

or towns and townships (for some

PSU’s in New England). The second

stage consists of a selection of facilities

from the sample PSU’s.

At the third stage, a systematic

random sample of ambulatory surgery

visits is selected. Sampled visits are

drawn from all locations within a

facility where ambulatory surgery is

performed, including main or general

operating rooms, all dedicated

ambulatory surgery rooms, cystoscopy

and endoscopy units, cardiac

catheterization labs, and laser procedure

rooms (in-scope locations). However,

locations within hospitals dedicated

exclusively to abortion, dentistry,

podiatry, pain block, or small procedures

(sometimes referred to as ‘‘lump and

bump’’ rooms) are not included. The

exclusion of these specialty locations, as

well as the exclusion of specialty

facilities, were recommended based on

the feasibility study for NSAS.

There were 751 hospitals and

freestanding ambulatory surgery centers

in the 1995 NSAS sample. Of these,

141 were found to be out of scope

(ineligible) because they went out of

business, performed less than 50

ambulatory procedures in the previous

year, or otherwise failed to meet the

criteria for NSAS. Of the 610 in-scope

(eligible) facilities, 489 responded to the

survey, for an overall response rate of

80 percent. The response rate was 89

percent for hospitals and 70 percent for

freestanding facilities.

Data collection

Sample selection and abstraction of

information from medical records were

performed at the facilities. Facility staff

did the sampling in about 44 percent of

facilities that participated in the 1995

survey, and facility staff abstracted the

data in approximately two-thirds of the

participating facilities. In the remaining

facilities, the work was performed by

personnel of the U.S. Bureau of the

Census acting on behalf of NCHS.

Completed abstract forms were sent to

NCHS for coding, editing, and

weighting.

The abstract form (figure 5)

contains items relating to the personal

characteristics of the patients such as

age, sex, race, and ethnicity. There are

administrative items such as date of

procedure, disposition, and expected

sources of payment. The medical

information includes up to seven

diagnoses and six procedures, which are

coded according to the International

Classification of Diseases, 9th Revision,

Clinical Modification (ICD–9–CM) (16).

Estimation and reliability of

estimates

Statistics from NSAS are derived by

a multistage estimation procedure that

produces essentially unbiased estimates.

The estimation procedure 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 statistics presented in this

report are based on a sample, and

therefore may differ from the figures

that would be obtained if a complete

census had been taken. The standard

error is primarily a measure of sampling

variability that occurs by chance

because only a sample rather than the

entire universe is surveyed. Standard

errors for the estimates in this report

were calculated with SUDAAN

software, which takes into account the

complex sample design. A description of

the software and approach it uses has

been published (17).

The chances are about 32 in 100

that an estimate from the sample would

differ from a complete census by more

than the standard error. The chances are

Figure 3. Rate of ambulatory surgery visits by age and sex: United States, 1995

Advance Data No. 296 + December 24, 1997 5
5 in 100 that the difference would be

more than twice the standard error, and

about 1 in 100 that the difference would

be more than 2.5 times as large as the

standard error. The relative standard

error is expressed as a percent of an

estimate and can be multiplied by the

estimate to obtain the standard error.

Because of low reliability, estimates

that have a relative standard error of

more than 30 percent or are based on a

sample of fewer than 30 records are not

presented. For these estimates, only an

asterisk (*) appears in the tables.

Estimates preceded by an asterisk (*)

are based on fewer than 60 records and

are also considered to have low

reliability.

Definitions and limitations

The estimates of procedures shown

in this report include surgical procedures

(such as tonsillectomy), diagnostic

procedures (such as cystoscopy), and

other therapeutic procedures (such as

injection or infusion of cancer

chemotherapeutic substance) reported on

the medical record. Data are shown for

all-listed procedures, which are all

occurrences of the procedures coded

regardless of their order on the medical

record. In contrast, diagnostic data for

ambulatory surgery visits are for the

diagnosis listed first on the medical

record.

Because certain freestanding

facilities and certain specialized

locations within hospitals and

freestanding facilities are excluded from

the NSAS design, ambulatory

procedures done in some specialties are

not completely measured by the survey.

Excluded specialties include dentistry,

podiatry, abortion, family planning,

birthing, pain block, and small

procedures (such as removal of skin

lesion). However, procedures in these

specialties performed in general

operating rooms or other in-scope

locations are included in the survey.

In addition, NSAS does not

completely measure ambulatory

procedures that are performed in

locations such as physicians’ offices, for

example, endoscopies of large and small

intestine, injections of therapeutic

substances, skin biopsies, and plastic

surgery. The National Ambulatory

Medical Care Survey has data about

procedures in physicians’ offices (7) and

the National Hospital Ambulatory

Medical Care Survey provides

information about procedures in hospital

outpatient and emergency departments

(8,9). As medical technology continues

to advance, increasing numbers and

types of procedures may move to

physicians’ offices and other locations

that are not within the scope of NSAS.

The determination of whether an

ambulatory surgery facility is a hospital

or a freestanding center is based on the

SMG universe from which the facility is

selected. In most cases, it is apparent

whether a facility is a hospital or a

freestanding ambulatory surgery center.

However, some facilities are not easily

classified. For example, a

‘‘freestanding’’ facility may be owned

by a hospital but located some distance

away. If such a facility is separately

listed in the 1993 SMG Freestanding

Outpatient Surgery Center Database (12)

and is selected into the NSAS sample

from this universe, it is considered a

freestanding facility.

According to the 1995 NSAS, an

estimated 321,000 ambulatory surgery

visits with procedures were discharged

to inpatient status. Of these, 313,000 (98

percent) were visits to hospitals and

8,000 (2 percent) were visits to

freestanding centers. In most instances,

the ambulatory procedures for these

patients become part of their inpatient

record. To avoid counting the

ambulatory procedures in both NSAS

and NHDS, these patients were excluded

from the NSAS data shown in this

report. These patients were included in

the summaries of outpatient procedures

as described in the first report from

NSAS (10).

Estimates in the tables have been

rounded to the nearest thousand.

Therefore, figures within tables do not

always add to the totals. Rates and

percents were calculated from

unrounded figures and may not agree

with rates or percents calculated from

rounded data.

The population estimates used in

computing rates are for the U.S. civilian

population, including institutionalized

persons, as of July 1, 1995. These

estimates were provided by the U.S.

Bureau of the Census and are consistent

with population estimates published in

Current Population Reports.

Tests of significance

In this report, statistical inference 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’’ indicate that differences are

statistically significant. Terms such as

‘‘similar’’ or ‘‘no difference’’ mean that

Figure 4. Number of selected procedures performed on ambulatory patients:

United States, 1995

6 Advance Data No. 296 + December 24, 1997
Table 4. Number of ambulatory surgery procedures, by procedure category, sex, and age: United States, 1995

[Excludes ambulatory surgery patients admitted to hospitals as inpatients. Procedure categories 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 Total

Sex Age

Male Female

Under

15 years

15–44

years

45–64

years

65 years

and over

Number in thousands

All procedures ................................................ 29,433 12,829 16,604 2,312 9,094 8,149 9,878

Operations on the nervous system ................................ 01–05 1,079 430 649 10 417 398 254

Injection of agent into spinal canal........................... 03.91–03.92 428 184 244 * 132 157 138

Release of carpal tunnel ..................................... 04.43 324 117 207 * 132 121 70

Operations on the eye........................................ 08–16 4,955 1,911 3,044 121 213 799 3,821

Operations on eyelids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08 215 87 127 14 25 68 108

Extraction of lens ...................................... 13.1–13.6 2,275 826 1,448 * 46 303 1,919

Insertion of prosthetic lens (pseudophakos) .......................... 13.7 1,723 637 1,086 * 36 242 1,440

Operations on the ear ........................................ 18–20 857 496 361 652 102 45 59

Myringotomy with insertion of tube............................... 20.01 558 326 232 521 20 *8 *9

Operations on the nose, mouth, and pharynx ......................... 21–29 2,061 1,089 972 706 801 392 162

Turbinectomy ............................................. 21.6 168 90 77 19 100 39 *9

Repair and plastic operations on the nose ........................... 21.8 268 149 119 *8 166 68 26

Operations on nasal sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 475 227 248 34 236 171 34

Operations on teeth, gums, and alveoli ............................ 23–24 230 124 106 165 42 *11 *12

Tonsillectomy with or without adenoidectomy ..................... 28.2–28.3 372 173 199 279 86 *5 *

Adenoidectomy without tonsillectomy .............................. 28.6 143 85 58 136 * * *

Operations on the respiratory system .............................. 30–34 387 214 172 30 65 131 161

Bronchoscopy with or without biopsy ..................... 33.21–33.24,33.27 170 93 76 9 21 57 83

Operations on the cardiovascular system ............................ 35–39 669 373 296 * 107 271 275

Cardiac catheterization .................................. 37.21–37.23 321 200 121 * 28 150 138

Operations on the digestive system ............................... 42–54 6,367 2,856 3,511 168 1,865 2,083 2,250

Esophagoscopy and gastroscopy ................... 42.21–42.24,44.11–44.14 143 74 69 5 32 47 58

Dilation of esophagus ...................................... 42.92 237 124 113 * 45 66 121

Endoscopy of small intestine with or without biopsy ............ 45.11–45.14,45.16 1,490 633 857 24 388 503 575

Endoscopy of large intestine with or without biopsy ................ 45.21–45.25 1,809 793 1,016 8 320 682 799

Endoscopic polypectomy of large intestine.......................... 45.42 512 271 241 * 46 193 272

Laparoscopic cholecystectomy ................................. 51.23 239 49 190 * 122 80 37

Repair of inguinal hernia .................................. 53.0–53.1 487 430 58 81 145 138 124

Laparoscopy ............................................ 54.21 408 37 371 * 341 49 *15

Operations on the urinary system................................. 55–59 1,374 839 535 55 322 415 583

Cystoscopy with or without biopsy ........................... 57.31–57.33 725 442 283 24 151 217 334

Operations on the male genital organs ............................. 60–64 496 496 . . . 129 148 93 125

Operations on the female genital organs ............................ 65–71 2,041 . . . 2,041 *6 1,518 402 115

Bilateral destruction or occlusion of fallopian tubes.................. 66.2–66.3 360 . . . 360 – 354 * –

Hysteroscopy............................................ 68.12 224 . . . 224 * 116 90 17

Dilation and curettage of uterus ................................. 69.0 534 . . . 534 * 321 163 49

Operations on the musculoskeletal system ........................... 76–84 4,036 2,132 1,904 156 1,988 1,335 557

Partial excision of bone ............................ 76.2–76.3,77.6–77.8 250 122 129 *8 113 92 38

Reduction of fracture ................................. 76.7,79.0–79.3 204 117 87 45 97 39 24

Removal of implanted devices from bone ....................... 76.97,78.6 167 87 80 14 92 37 25

Excision and repair of bunion and other toe deformities................... 77.5 249 53 196 * 87 101 54

Arthroscopy of knee........................................ 80.26 636 377 259 12 357 204 63

Excision of semilunar cartilage of knee ............................. 80.6 460 285 175 * 224 169 59

Replacement or other repair of knee ................. 81.42–81.47,81.54–81.55 249 142 108 * 146 81 19

Operations on muscle, tendon, fascia, and bursa...................... 82–83 637 300 337 29 264 230 113

Operations on the integumentary system ............................ 85–86 2,180 624 1,556 108 808 741 524

Biopsy of breast ...................................... 85.11–85.12 350 *11 339 * 122 136 91

Local excision of lesion of breast (lumpectomy)....................... 85.21 332 *12 320 * 119 136 74

Excision or destruction of lesion or tissue of skin and subcutaneous tissue. . . 86.2–86.4 831 397 433 68 313 236 214

Miscellaneous diagnostic and therapeutic procedures .................... 87–99 2,770 1,326 1,444 147 679 992 952

Arteriography and angiocardiography using contrast material ........... 88.4–88.5 525 325 199 * 41 238 242

Injection or infusion of therapeutic or prophylactic substance ........... 99.1–99.2 379 164 214 8 110 141 119

Operations on the endocrine system, operations on the hemic and

lymphatic system, and obstetrical procedures ............... 06–07,40–41,72–75 162 42 119 10 62 50 40

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.

– Quantity zero.

NOTE: The standard error of a number can be obtained by multiplying the estimate by the corresponding relative standard error, shown as a percent, in table 6.

Advance Data No. 296 + December 24, 1997 7
Table 5. Rate of ambulatory surgery procedures, by procedure category, sex, and age: United States, 1995

[Excludes ambulatory surgery patients admitted to hospitals as inpatients. Procedure categories 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 Total

Sex Age

Male Female

Under

15 years

15–44

years

45–64

years

65 years

and over

Rate per 10,000 population

All procedures ................................................ 1,125.9 1,009.1 1,236.6 400.6 770.8 1,561.8 2,945.9

Operations on the nervous system ................................ 01–05 41.3 33.8 48.3 1.7 35.4 76.3 75.7

Injection of agent into spinal canal........................... 03.91–03.92 16.4 14.5 18.2 * 11.2 30.0 41.2

Release of carpal tunnel ..................................... 04.43 12.4 9.2 15.4 * 11.2 23.2 20.8

Operations on the eye........................................ 08–16 189.5 150.3 226.7 21.0 18.1 153.2 1,139.5

Operations on eyelids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08 8.2 6.9 9.5 2.4 2.1 13.0 32.2

Extraction of lens ...................................... 13.1–13.6 87.0 65.0 107.9 * 3.9 58.1 572.4

Insertion of prosthetic lens (pseudophakos) .......................... 13.7 65.9 50.1 80.9 * 3.1 46.3 429.4

Operations on the ear ........................................ 18–20 32.8 39.0 26.9 112.9 8.6 8.7 17.5

Myringotomy with insertion of tube............................... 20.01 21.4 25.6 17.3 90.2 1.7 *1.5 *2.8

Operations on the nose, mouth, and pharynx ......................... 21–29 78.8 85.6 72.4 122.2 67.9 75.2 48.4

Turbinectomy ............................................. 21.6 6.4 7.1 5.8 3.3 8.5 7.4 *2.8

Repair and plastic operations on the nose ........................... 21.8 10.2 11.7 8.9 *1.4 14.1 13.1 7.7

Operations on nasal sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 18.2 17.8 18.5 5.9 20.0 32.7 10.2

Operations on teeth, gums, and alveoli ............................ 23–24 8.8 9.7 7.9 28.6 3.5 *2.1 *3.6

Tonsillectomy with or without adenoidectomy ..................... 28.2–28.3 14.2 13.6 14.8 48.3 7.3 *1.0 *

Adenoidectomy without tonsillectomy .............................. 28.6 5.5 6.7 4.3 23.5 * * *

Operations on the respiratory system .............................. 30–34 14.8 16.9 12.8 5.2 5.5 25.0 48.2

Bronchoscopy with or without biopsy ..................... 33.21–33.24,33.27 6.5 7.4 5.7 1.6 1.7 10.9 24.8

Operations on the cardiovascular system ............................ 35–39 25.6 29.3 22.0 * 9.1 51.9 82.0

Cardiac catheterization .................................. 37.21–37.23 12.3 15.7 9.0 * 2.4 28.8 41.2

Operations on the digestive system ............................... 42–54 243.6 224.6 261.5 29.1 158.1 399.3 671.1

Esophagoscopy and gastroscopy ................... 42.21–42.24,44.11–44.14 5.5 5.8 5.1 0.9 2.7 9.1 17.4

Dilation of esophagus ...................................... 42.92 9.1 9.7 8.4 * 3.8 12.7 36.1

Endoscopy of small intestine with or without biopsy ............ 45.11–45.14,45.16 57.0 49.8 63.8 4.2 32.9 96.4 171.6

Endoscopy of large intestine with or without biopsy ................ 45.21–45.25 69.2 62.4 75.7 1.4 27.2 130.6 238.2

Endoscopic polypectomy of large intestine.......................... 45.42 19.6 21.3 17.9 * 3.9 36.9 81.2

Laparoscopic cholecystectomy ................................. 51.23 9.1 3.9 14.1 * 10.3 15.4 10.9

Repair of inguinal hernia .................................. 53.0–53.1 18.6 33.8 4.3 14.1 12.3 26.4 37.0

Laparoscopy ............................................ 54.21 15.6 2.9 27.7 * 28.9 9.4 *4.6

Operations on the urinary system................................. 55–59 52.6 66.0 39.9 9.5 27.3 79.6 173.7

Cystoscopy with or without biopsy ........................... 57.31–57.33 27.7 34.8 21.1 4.1 12.8 41.5 99.6

Operations on the male genital organs ............................. 60–64 19.0 39.0 . . . 22.3 12.6 17.9 37.4

Operations on the female genital organs ............................ 65–71 78.1 . . . 152.0 *1.0 128.7 77.0 34.3

Bilateral destruction or occlusion of fallopian tubes.................. 66.2–66.3 13.8 . . . 26.8 – 30.0 * –

Hysteroscopy............................................ 68.12 8.6 . . . 16.7 * 9.8 17.3 5.2

Dilation and curettage of uterus ................................. 69.0 20.4 . . . 39.8 * 27.2 31.3 14.7

Operations on the musculoskeletal system ........................... 76–84 154.4 167.7 141.8 27.1 168.5 255.9 166.0

Partial excision of bone ............................ 76.2–76.3,77.6–77.8 9.6 9.6 9.6 *1.4 9.5 17.6 11.3

Reduction of fracture ................................. 76.7,79.0–79.3 7.8 9.2 6.4 7.7 8.2 7.4 7.2

Removal of implanted devices from bone ....................... 76.97,78.6 6.4 6.9 5.9 2.4 7.8 7.0 7.3

Excision and repair of bunion and other toe deformities................... 77.5 9.5 4.2 14.6 * 7.4 19.3 16.2

Arthroscopy of knee........................................ 80.26 24.3 29.6 19.3 2.1 30.3 39.0 18.7

Excision of semilunar cartilage of knee ............................. 80.6 17.6 22.4 13.0 * 19.0 32.4 17.7

Replacement or other repair of knee ................. 81.42–81.47,81.54–81.55 9.5 11.1 8.0 * 12.4 15.6 5.6

Operations on muscle, tendon, fascia, and bursa...................... 82–83 24.4 23.6 25.1 5.0 22.4 44.2 33.7

Operations on the integumentary system ............................ 85–86 83.4 49.1 115.9 18.7 68.5 142.1 156.2

Biopsy of breast ...................................... 85.11–85.12 13.4 *0.8 25.3 * 10.4 26.0 27.2

Local excision of lesion of breast (lumpectomy)....................... 85.21 12.7 *1.0 23.8 * 10.1 26.0 22.1

Excision or destruction of lesion or tissue of skin and subcutaneous tissue. . . 86.2–86.4 31.8 31.2 32.3 11.8 26.5 45.2 63.9

Miscellaneous diagnostic and therapeutic procedures .................... 87–99 105.9 104.3 107.5 25.4 57.6 190.1 283.9

Arteriography and angiocardiography using contrast material ........... 88.4–88.5 20.1 25.6 14.8 * 3.5 45.7 72.3

Injection or infusion of therapeutic or prophylactic substance ........... 99.1–99.2 14.5 12.9 16.0 1.4 9.3 27.1 35.5

Operations on the endocrine system, operations on the hemic and

lymphatic system, and obstetrical procedures ............... 06–07,40–41,72–75 6.2 3.3 8.9 1.7 5.3 9.5 12.0

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.

– Quantity zero.

NOTE: The standard error of a rate can be obtained by multiplying the estimate by the corresponding relative standard error, shown as a percent, in table 6.

8 Advance Data No. 296 + December 24, 1997
Table 6. Relative standard errors for number and rate of ambulatory surgery procedures, by procedure category, sex, and age:

United States, 1995

[Procedure categories 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 Total

Sex Age

Male Female

Under

15 years

15–44

years

45–64

years

65 years

and over

Standard error as a percent of the number or rate of procedures

All procedures ................................................ 4.33 4.36 4.44 5.32 4.79 5.34 4.69

Operations on the nervous system ................................ 01–05 8.06 8.29 8.33 25.12 8.28 8.57 10.48

Injection of agent into spinal canal........................... 03.91–03.92 13.05 12.52 14.04 * 13.59 13.87 15.84

Release of carpal tunnel ..................................... 04.43 6.00 7.41 6.76 * 8.50 7.53 7.91

Operations on the eye........................................ 08–16 6.00 6.55 5.89 12.91 11.43 6.36 6.49

Operations on eyelids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08 7.83 9.95 8.53 21.52 13.28 15.00 8.78

Extraction of lens ...................................... 13.1–13.6 7.79 8.50 7.54 * 18.43 7.36 8.18

Insertion of prosthetic lens (pseudophakos) .......................... 13.7 5.85 6.29 5.85 * 23.06 6.11 6.13

Operations on the ear ........................................ 18–20 5.68 6.04 6.06 5.87 11.19 12.26 13.54

Myringotomy with insertion of tube............................... 20.01 6.16 6.72 6.60 6.27 18.82 *26.41 *28.95

Operations on the nose, mouth, and pharynx ......................... 21–29 5.95 6.21 6.26 7.19 6.52 13.83 8.59

Turbinectomy ............................................. 21.6 10.54 11.14 12.03 24.62 10.50 13.79 *27.77

Repair and plastic operations on the nose ........................... 21.8 6.96 7.80 8.63 *22.27 7.51 10.30 18.10

Operations on nasal sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 13.25 14.03 13.97 14.04 9.98 26.92 21.07

Operations on teeth, gums, and alveoli ............................ 23–24 15.77 17.70 14.97 18.61 18.37 *27.75 *20.20

Tonsillectomy with or without adenoidectomy ..................... 28.2–28.3 6.98 7.66 7.41 7.42 8.22 *26.82 *

Adenoidectomy without tonsillectomy .............................. 28.6 8.88 10.20 10.11 9.01 * * *

Operations on the respiratory system .............................. 30–34 7.93 9.89 7.95 15.92 11.00 8.86 11.60

Bronchoscopy with or without biopsy ..................... 33.21–33.24,33.27 11.30 13.63 12.28 20.96 19.94 13.72 12.50

Operations on the cardiovascular system ............................ 35–39 10.02 11.42 8.98 * 10.62 11.68 10.56

Cardiac catheterization .................................. 37.21–37.23 13.25 12.98 14.70 * 17.69 14.07 13.93

Operations on the digestive system ............................... 42–54 5.65 5.44 6.08 10.41 5.39 6.28 6.86

Esophagoscopy and gastroscopy ................... 42.21–42.24,44.11–44.14 13.93 13.33 16.89 21.60 18.83 16.00 16.17

Dilation of esophagus ...................................... 42.92 12.97 12.38 15.48 * 21.12 14.34 12.98

Endoscopy of small intestine with or without biopsy ............ 45.11–45.14,45.16 8.36 8.20 8.89 25.37 9.06 9.10 8.50

Endoscopy of large intestine with or without biopsy ................ 45.21–45.25 7.46 7.48 7.73 22.95 8.12 8.17 8.10

Endoscopic polypectomy of large intestine.......................... 45.42 9.17 9.29 10.17 * 14.44 9.70 10.15

Laparoscopic cholecystectomy ................................. 51.23 9.39 10.86 10.04 * 11.86 9.73 13.05

Repair of inguinal hernia .................................. 53.0–53.1 5.13 4.88 12.37 10.92 7.56 7.35 8.96

Laparoscopy ............................................ 54.21 6.19 14.43 6.26 * 6.43 12.95 *25.35

Operations on the urinary system................................. 55–59 7.94 7.83 10.44 15.48 9.94 9.03 8.90

Cystoscopy with or without biopsy ........................... 57.31–57.33 9.64 9.33 12.10 19.41 10.27 10.07 11.00

Operations on the male genital organs ............................. 60–64 6.29 6.29 . . . 8.86 9.57 9.39 9.59

Operations on the female genital organs ............................ 65–71 4.98 . . . 4.98 *21.26 5.28 7.57 11.47

Bilateral destruction or occlusion of fallopian tubes.................. 66.2–66.3 8.95 . . . 8.95 – 9.01 * –

Hysteroscopy............................................ 68.12 7.78 . . . 7.78 * 8.76 10.80 17.18

Dilation and curettage of uterus ................................. 69.0 5.40 . . . 5.40 * 6.10 8.04 10.13

Operations on the musculoskeletal system ........................... 76–84 6.32 6.84 6.35 8.77 7.09 6.98 6.45

Partial excision of bone ............................ 76.2–76.3,77.6–77.8 8.07 9.10 9.94 *17.97 9.75 10.55 10.54

Reduction of fracture ................................. 76.7,79.0–79.3 6.78 7.65 8.29 10.82 8.32 12.34 13.83

Removal of implanted devices from bone ....................... 76.97,78.6 10.58 12.91 11.75 20.08 13.29 11.65 19.46

Excision and repair of bunion and other toe deformities................... 77.5 11.37 24.46 9.60 * 12.51 16.25 10.39

Arthroscopy of knee........................................ 80.26 7.39 7.68 8.45 22.59 8.23 8.20 10.26

Excision of semilunar cartilage of knee ............................. 80.6 7.49 7.91 8.45 * 8.25 8.48 11.33

Replacement or other repair of knee ................. 81.42–81.47,81.54–81.55 10.69 10.81 12.33 * 12.15 12.17 18.53

Operations on muscle, tendon, fascia, and bursa...................... 82–83 5.62 5.91 6.66 10.91 6.41 7.95 7.26

Operations on the integumentary system ............................ 85–86 4.35 5.33 4.53 8.36 5.61 5.15 4.87

Biopsy of breast ...................................... 85.11–85.12 6.58 *25.56 6.55 * 8.20 7.57 9.68

Local excision of lesion of breast (lumpectomy)....................... 85.21 8.20 *20.63 8.27 * 10.30 11.22 11.75

Excision or destruction of lesion or tissue of skin and

subcutaneous tissue ................................... 86.2–86.4 5.27 5.71 5.86 8.85 6.87 6.34 5.96

Miscellaneous diagnostic and therapeutic procedures .................... 87–99 14.32 12.71 16.04 11.38 15.40 16.98 12.86

Arteriography and angiocardiography using contrast material ........... 88.4–88.5 12.42 12.14 13.99 * 17.02 13.48 13.71

Injection or infusion of therapeutic or prophylactic substance ........... 99.1–99.2 12.42 14.16 11.91 24.02 12.86 13.96 16.31

Operations on the endocrine system, operations on the hemic and lymphatic system,

and obstetrical procedures ........................... 06–07,40–41,72–75 10.00 10.52 12.65 18.82 14.87 13.66 15.51

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.

– Quantity zero.

NOTE: The standard error of a number or rate in tables 4 or 5 can be obtained by multiplying the estimate by the corresponding relative standard error, shown as a percent, in this table.

Advance Data No. 296 + December 24, 1997 9
Table 7. Number of ambulatory surgery visits by first-listed diagnosis, sex, and age: United States, 1995

[Excludes ambulatory surgery patients admitted to hospitals as inpatients. Diagnostic categories and code numbers are based on the International Classification of

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

Category of first-listed diagnosis and ICD–9–CM code Total

Sex Age

Male Female

Under

15 years

15–44

years

45–64

years

65 years

and over

Number in thousands

All conditions ................................................... 19,638 8,527 11,111 1,708 6,015 5,410 6,505

Infectious and parasitic diseases ..................................001–139 112 57 55 13 65 21 *14

Neoplasms................................................140–239 1,806 835 971 51 356 599 800

Malignant neoplasms .................................. 140–208,230–234 738 342 396 10 109 239 380

Malignant neoplasm of skin........................... 172–173,176.0,198.2 159 88 71 * 17 42 99

Malignant neoplasm of breast ............................ 174–175,198.81 122 * 121 * 23 53 45

Benign neoplasms..........................................210–229 960 438 522 37 234 333 357

Benign neoplasm of colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211.3 572 317 255 * 49 223 299

Lipoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 103 44 59 * 50 36 16

Endocrine, nutritional and metabolic diseases, and immunity disorders...........240–279 114 46 68 * 31 46 34

Diseases of the nervous system and sense organs.......................320–389 3,878 1,578 2,300 610 376 631 2,261

Carpal tunnel syndrome ........................................354.0 317 114 204 * 127 120 69

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 108 42 67 * *5 26 75

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366 2,242 811 1,431 * 42 300 1,893

Otitis media and eustachian tube disorders ..........................381–382 528 304 224 484 26 8 *9

Diseases of the circulatory system .................................390–459 688 364 324 *2 142 280 264

Heart disease ....................391–392.0,393–398,402,404,410–416,420–429 293 184 109 * 27 127 138

Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 215 94 121 * 66 96 52

Diseases of the respiratory system .................................460–519 874 437 438 327 292 162 93

Deviated nasal septum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470 131 76 56 * 87 34 *8

Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473 144 60 84 14 68 55 *7

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474 351 162 189 275 73 * *

Diseases of the digestive system ..................................520–579 3,221 1,581 1,640 215 909 1,038 1,059

Diseases of teeth and supporting structures ..........................520–525 137 71 66 95 30 *7 *6

Diseases of esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530 439 220 220 7 121 144 166

Ulcer of stomach and small intestine ..............................531–534 103 42 61 * 20 40 44

Gastritis and duodenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535 358 130 228 * 109 123 123

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 469 413 56 70 143 132 123

Noninfectious enteritis and colitis ................................555–558 202 85 117 * 77 71 50

Diverticula of intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562 326 127 199 * * 101 213

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 214 44 171 * 105 70 39

Diseases of the genitourinary system ...............................580–629 2,226 638 1,588 102 970 694 460

Calculus of kidney and ureter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 193 124 69 * 75 86 30

Hematuria.................................................599.7 90 54 36 * 21 33 36

Benign mammary dysplasias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 150 * 150 * 52 63 35

Lump or mass in breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611.72 229 *10 219 * 87 90 51

Disorders of menstruation and other abnormal vaginal bleeding ..........626,627.0–627.1 264 . . . 264 – 119 113 32

Complications of pregnancy, childbirth, and the puerperium..................630–676 222 . . . 222 * 220 * –

Abortion and ectopic and molar pregnancy ..........................630–639 187 . . . 187 * 186 * –

Diseases of the skin and subcutaneous tissue..........................680–709 433 209 224 32 174 120 107

Sebaceous cyst .............................................706.2 125 68 58 *9 50 38 28

Diseases of the musculoskeletal system and connective tissue ...............710–739 1,885 840 1,045 46 774 695 371

Arthropathies and related disorders ...............................710–719 465 242 223 14 217 167 67

Internal derangement of knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 717 194 106 88 * 108 64 17

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 136 70 66 * 58 60 18

Lumbago .................................................724.2 95 39 56 – 32 37 26

Rheumatism, excluding back ...................................725–729 634 281 353 16 272 235 111

Acquired deformities of toe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 735 139 31 108 * 49 54 30

Congenital anomalies .........................................740–759 183 90 93 86 59 24 14

Symptoms, signs, and ill-defined conditions ...........................780–799 1,189 504 685 49 356 396 388

Abdominal pain .............................................789.0 227 81 147 * 89 75 57

Injury and poisoning ..........................................800–999 1,217 730 487 116 600 306 196

Fractures ...............................................800–829 273 168 104 55 146 45 27

Current tear of medial cartilage or meniscus of knee ......................836.0 245 162 84 * 128 88 27

Supplementary classification .................................... V01–V82 1,451 560 890 51 660 366 374

Visit for sterilization .......................................... V25.2 385 59 327 – 373 12 *

Diseases of the blood and blood-forming organs, mental disorders, and certain

conditions originating in the perinatal period .............. 280–289,290–319,760–779 139 57 81 *6 32 31 69

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.

– Quantity zero.

NOTE: The standard error of a number can be obtained by multiplying the estimate by the corresponding relative standard error, shown as a percent, in table 9.

10 Advance Data No. 296 + December 24, 1997
Table 8. Rate of ambulatory surgery visits by first-listed diagnosis, sex, and age: United States, 1995

[Excludes ambulatory surgery patients admitted to hospitals as inpatients. Diagnostic categories and code numbers are based on the International Classification of

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

Category of first-listed diagnosis and ICD–9–CM code Total

Sex Age

Male Female

Under

15 years

15–44

years

45–64

years

65 years

and over

Rate per 10,000 population

All conditions ................................................... 751.3 670.7 827.5 295.9 509.8 1,037.0 1,939.9

Infectious and parasitic diseases ..................................001–139 4.3 4.5 4.1 2.2 5.5 4.0 *4.0

Neoplasms................................................140–239 69.1 65.7 72.3 8.8 30.2 114.8 238.6

Malignant neoplasms .................................. 140–208,230–234 28.2 26.9 29.5 1.8 9.2 45.9 113.2

Malignant neoplasm of skin........................... 172–173,176.0,198.2 6.1 6.9 5.3 * 1.4 8.1 29.5

Malignant neoplasm of breast ............................ 174–175,198.81 4.7 * 9.0 * 2.0 10.2 13.4

Benign neoplasms..........................................210–229 36.7 34.5 38.9 6.4 19.8 63.8 106.4

Benign neoplasm of colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211.3 21.9 24.9 19.0 * 4.2 42.7 89.1

Lipoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 3.9 3.4 4.4 * 4.2 6.8 4.9

Endocrine, nutritional and metabolic diseases, and immunity disorders...........240–279 4.4 3.6 5.1 * 2.6 8.9 10.3

Diseases of the nervous system and sense organs.......................320–389 148.4 124.1 171.3 105.6 31.8 121.0 674.4

Carpal tunnel syndrome ........................................354.0 12.1 8.9 15.2 * 10.8 23.0 20.5

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 4.1 3.3 5.0 * *0.4 5.1 22.4

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366 85.8 63.8 106.6 * 3.6 57.6 564.5

Otitis media and eustachian tube disorders ..........................381–382 20.2 23.9 16.7 83.9 2.2 1.6 *2.6

Diseases of the circulatory system .................................390–459 26.3 28.7 24.1 *0.4 12.0 53.7 78.7

Heart disease ....................391–392.0,393–398,402,404,410–416,420–429 11.2 14.4 8.1 * 2.3 24.4 41.3

Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 8.2 7.4 9.0 * 5.6 18.4 15.6

Diseases of the respiratory system .................................460–519 33.4 34.3 32.6 56.6 24.7 31.1 27.8

Deviated nasal septum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470 5.0 6.0 4.1 * 7.4 6.4 *2.5

Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473 5.5 4.7 6.3 2.3 5.8 10.6 *2.2

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474 13.4 12.7 14.1 47.6 6.2 * *

Diseases of the digestive system ..................................520–579 123.2 124.4 122.1 37.3 77.1 198.9 315.9

Diseases of teeth and supporting structures ..........................520–525 5.2 5.5 5.0 16.4 2.5 *1.3 *1.7

Diseases of esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530 16.8 17.3 16.4 1.3 10.3 27.7 49.5

Ulcer of stomach and small intestine ..............................531–534 3.9 3.3 4.6 * 1.7 7.6 13.1

Gastritis and duodenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535 13.7 10.3 17.0 * 9.2 23.6 36.8

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 17.9 32.5 4.2 12.2 12.2 25.3 36.8

Noninfectious enteritis and colitis ................................555–558 7.7 6.7 8.7 * 6.5 13.6 14.9

Diverticula of intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562 12.5 10.0 14.8 * * 19.4 63.6

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 8.2 3.4 12.7 * 8.9 13.4 11.5

Diseases of the genitourinary system ...............................580–629 85.2 50.2 118.3 17.7 82.2 133.0 137.2

Calculus of kidney and ureter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 7.4 9.8 5.1 * 6.4 16.5 9.0

Hematuria.................................................599.7 3.5 4.2 2.7 * 1.8 6.3 10.7

Benign mammary dysplasias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 5.7 * 11.1 * 4.4 12.0 10.5

Lump or mass in breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611.72 8.7 *0.7 16.3 * 7.4 17.2 15.1

Disorders of menstruation and other abnormal vaginal bleeding.........626,627.0–627.1 10.1 . . . 19.7 – 10.1 21.6 9.6

Complications of pregnancy, childbirth, and the puerperium..................630–676 8.5 . . . 16.5 * 18.7 * –

Abortion and ectopic and molar pregnancy ..........................630–639 7.1 . . . 13.9 * 15.7 * –

Diseases of the skin and subcutaneous tissue..........................680–709 16.6 16.5 16.7 5.6 14.8 23.0 31.9

Sebaceous cyst .............................................706.2 4.8 5.3 4.3 *1.5 4.2 7.4 8.4

Diseases of the musculoskeletal system and connective tissue ...............710–739 72.1 66.1 77.8 7.9 65.6 133.2 110.6

Arthropathies and related disorders ...............................710–719 17.8 19.0 16.6 2.4 18.4 32.0 20.0

Internal derangement of knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 717 7.4 8.3 6.6 * 9.1 12.2 5.0

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 5.2 5.5 4.9 * 4.9 11.5 5.4

Lumbago .................................................724.2 3.6 3.1 4.1 – 2.7 7.1 7.7

Rheumatism, excluding back ...................................725–729 24.2 22.1 26.3 2.7 23.1 45.1 33.1

Acquired deformities of toe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 735 5.3 2.4 8.0 * 4.2 10.4 9.0

Congenital anomalies .........................................740–759 7.0 7.1 6.9 15.0 5.0 4.6 4.2

Symptoms, signs, and ill-defined conditions ...........................780–799 45.5 39.6 51.0 8.5 30.2 75.9 115.7

Abdominal pain .............................................789.0 8.7 6.3 10.9 * 7.6 14.4 17.0

Injury and poisoning ..........................................800–999 46.6 57.4 36.2 20.0 50.8 58.7 58.4

Fractures ...............................................800–829 10.4 13.2 7.8 9.5 12.4 8.6 8.0

Current tear of medial cartilage or meniscus of knee ......................836.0 9.4 12.7 6.2 * 10.8 16.9 8.1

Supplementary classification .................................... V01–V82 55.5 44.1 66.3 8.8 55.9 70.1 111.5

Visit for sterilization .......................................... V25.2 14.7 4.6 24.3 – 31.6 2.4 *

Diseases of the blood and blood-forming organs, mental disorders, and certain

conditions originating in the perinatal period .............. 280–289,290–319,760–779 5.3 4.5 6.1 *1.0 2.7 6.0 20.7

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.

– Quantity zero.

NOTE: The standard error of a rate can be obtained by multiplying the estimate by the corresponding relative standard error, shown as a percent, in table 9.

Advance Data No. 296 + December 24, 1997 11
Table 9. Relative standard errors for number and rate of ambulatory surgery visits, by first-listed diagnosis, sex, and age: United States,

1995

[Diagnostic categories and code numbers are based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM)]

Category of first-listed diagnosis and ICD–9–CM code Total

Sex Age

Male Female

Under

15 years

15–44

years

45–64

years

65 years

and over

Standard error as a percent of the number or rate of visits

All conditions ................................................... 4.44 4.39 4.59 5.15 4.82 5.40 4.96

Infectious and parasitic diseases ..................................001–139 8.33 11.48 10.73 19.11 11.88 16.83 *23.13

Neoplasms................................................140–239 5.61 6.14 5.75 12.17 6.73 7.04 6.45

Malignant neoplasms .................................. 140–208,230–234 6.16 6.89 7.04 26.58 9.51 9.11 6.03

Malignant neoplasm of skin........................... 172–173,176.0,198.2 8.55 10.07 9.60 * 18.45 12.80 9.37

Malignant neoplasm of breast ............................ 174–175,198.81 9.22 * 9.19 * 17.37 12.49 14.52

Benign neoplasms..........................................210–229 6.76 7.82 6.66 11.89 7.21 7.85 9.60

Benign neoplasm of colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211.3 9.30 9.42 10.26 * 11.92 9.70 10.79

Lipoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 7.95 10.71 10.50 * 10.58 11.66 19.49

Endocrine, nutritional and metabolic diseases, and immunity disorders...........240–279 10.64 14.27 10.12 * 12.14 15.05 15.94

Diseases of the nervous system and sense organs.......................320–389 5.46 5.52 5.57 5.80 6.35 5.56 7.32

Carpal tunnel syndrome ........................................354.0 6.01 7.17 6.79 * 8.54 7.29 8.00

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 11.57 13.98 12.36 * *28.52 14.20 12.53

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366 7.80 8.50 7.57 * 19.60 7.44 8.18

Otitis media and eustachian tube disorders ..........................381–382 6.37 7.03 6.90 6.42 17.13 26.27 *27.48

Diseases of the circulatory system .................................390–459 9.31 9.64 9.75 *22.93 8.70 10.56 11.23

Heart disease ....................391–392.0,393–398,402,404,410–416,420–429 13.61 12.67 16.17 * 25.24 14.95 14.04

Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 9.13 8.63 11.77 * 10.56 11.02 12.63

Diseases of the respiratory system .................................460–519 5.91 6.58 5.87 6.95 6.27 12.87 12.59

Deviated nasal septum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470 8.36 10.29 10.29 * 9.27 11.36 *24.12

Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473 11.56 13.00 12.97 16.21 10.73 23.59 *21.72

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474 6.56 7.01 7.15 7.13 8.32 * *

Diseases of the digestive system ..................................520–579 5.80 5.04 6.99 10.79 5.82 6.78 6.98

Diseases of teeth and supporting structures ..........................520–525 15.09 17.53 14.45 17.98 18.49 *26.79 *21.82

Diseases of esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530 9.91 9.44 12.03 24.71 12.38 10.60 11.18

Ulcer of stomach and small intestine ..............................531–534 11.13 13.61 12.27 * 14.64 15.05 13.62

Gastritis and duodenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535 10.82 10.80 11.69 * 12.55 11.58 11.76

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 5.28 5.09 12.47 11.23 7.48 7.33 8.95

Noninfectious enteritis and colitis ................................555–558 10.16 12.26 10.60 * 10.13 13.06 14.20

Diverticula of intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562 10.57 10.61 11.95 * * 10.02 11.77

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 9.10 10.05 10.02 * 12.72 10.19 12.77

Diseases of the genitourinary system ...............................580–629 5.21 6.71 5.17 9.22 5.31 5.70 7.37

Calculus of kidney and ureter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 10.62 11.31 12.47 * 13.59 12.24 14.94

Hematuria.................................................599.7 11.94 14.07 13.45 * 18.27 14.74 13.54

Benign mammary dysplasias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 11.48 * 11.50 * 12.23 16.63 19.69

Lump or mass in breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611.72 8.18 *29.19 8.21 * 10.37 10.23 13.23

Disorders of menstruation and other abnormal vaginal bleeding.........626,627.0–627.1 7.12 . . . 7.12 – 8.38 9.53 12.54

Complications of pregnancy, childbirth, and the puerperium..................630–676 8.69 . . . 8.69 * 8.75 * –

Abortion and ectopic and molar pregnancy ..........................630–639 9.06 . . . 9.06 * 9.11 * –

Diseases of the skin and subcutaneous tissue..........................680–709 6.12 6.86 7.09 10.88 8.07 8.18 7.95

Sebaceous cyst...............................................706.2 8.82 9.91 11.76 *26.03 12.58 14.15 13.96

Diseases of the musculoskeletal system and connective tissue ...............710–739 7.85 8.43 7.66 12.95 7.26 8.94 10.60

Arthropathies and related disorders ...............................710–719 7.37 7.94 8.09 27.38 7.71 8.46 13.83

Internal derangement of knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 717 7.52 8.79 8.48 * 8.74 9.79 19.84

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 14.66 15.63 16.16 * 14.41 19.23 18.31

Lumbago .................................................724.2 16.32 17.50 16.60 – 19.06 17.81 19.21

Rheumatism, excluding back ...................................725–729 7.29 9.54 6.44 15.24 7.81 7.78 11.08

Acquired deformities of toe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 735 12.59 24.93 10.75 * 15.27 16.06 12.13

Congenital anomalies .........................................740–759 7.65 9.83 9.70 10.29 11.41 16.68 21.63

Symptoms, signs, and ill-defined conditions ...........................780–799 10.15 10.23 10.49 13.68 12.46 10.58 10.31

Abdominal pain .............................................789.0 13.68 16.59 12.87 * 12.91 16.92 19.95

Injury and poisoning ..........................................800–999 5.59 6.25 5.50 7.24 6.35 7.43 7.69

Fractures ...............................................800–829 6.62 7.57 8.00 9.09 8.03 11.74 12.81

Current tear of medial cartilage or meniscus of knee ......................836.0 9.66 9.62 12.90 * 9.54 12.46 15.62

Supplementary classification .................................... V01–V82 7.86 9.08 7.97 12.08 7.49 11.87 10.53

Admission for sterilization ...................................... V25.2 8.78 17.55 9.12 – 8.69 24.98 *

Diseases of the blood and blood-forming organs, mental disorders, and certain

conditions originating in the perinatal period .............. 280–289,290–319,760–779 14.74 13.37 18.11 *25.46 26.58 15.80 21.34

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.

– Quantity zero.

NOTE: The standard error of a number or rate in table 7 or 8 can be obtained by multiplying the estimate by the corresponding relative standard error, shown as a percent, in this table.

12 Advance Data No. 296 + December 24, 1997
Figure 5. Medical abstract for the National Survey of Ambulatory Surgery, 1994.

Advance Data No. 296 + December 24, 1997 13
Figure 5. Medical abstract for the National Survey of Ambulatory Surgery, 1994—Con.

14 Advance Data No. 296 + December 24, 1997
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 to be significant.

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Advance Data No. 296+ December 24, 1997 15
Suggested citation

Hall MJ and Lawrence L. Ambulatory surgery

in the United States, 1995. Advance data from

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Maryland: National Center for Health

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