Ambulatory Surgery in the United States, 1996

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

Highlights

Ambulatory Surgery Visits

+ In 1996, an estimated 31.5 million

surgical and nonsurgical procedures

were performed during 20.8 million

ambulatory surgery visits (table 1).

+ The 20.8 million ambulatory surgery

visits accounted for about half of the

combined total of ambulatory surgery

visits and inpatient discharges with

surgical and nonsurgical procedures

(40.1 million) (table 1, figure 1).

+ An estimated 17.5 million

(84 percent) of the ambulatory

surgery visits occurred in hospitals

and 3.3 million (16 percent) occurred

in freestanding centers (table 2,

figure 2).

+ Females had significantly more

ambulatory surgery visits (11.7

million) than males (9.1 million), and

a significantly higher rate of visits

(86.7 per 1,000 population) compared

with males (70.8 per 1,000

population) (table 3).

+ The rate of ambulatory surgery visits

per 1,000 population was higher for

males (35.1) than for females (25.5)

under 15 years of age and higher for

females than for males for the 15–44

age group (65.8 versus 40.8), but

there was no significant difference in

the rates for males and females for

the age groups 45–64 years old

(100.6 versus 113.4) and 65 years of

age and over (219.6 versus 197.7)

(table 3, figure 3).

Ambulatory Procedures

+ Females had significantly more

ambulatory surgery procedures (17.6

million) than males (13.9 million) and

a significantly higher rate of

procedures (1,302.5 per 10,000

population) compared with males

(1,078.8 per 10,000 population)

(tables 4–6).

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 1996. Data are presented by

types of facilities, age and sex of the patient, and geographic region. Major

categories of procedures and diagnoses are shown by age, sex, and region.

Methods—The estimates are based on data collected by the 1996 National

Survey of Ambulatory Surgery conducted by the National Center for Health

Statistics. The 1996 data were abstracted from 125,000 medical records in 488

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. Iris Shimizu, Office of Research and Methodology, assisted with estimation and variances. Maria Owings

produced standard errors. Computer programming was done by Rong Cai and Flora Lan 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 M. Cox and typeset by Annette F. Holman of the Publications Branch, Division of Data Services.

Number 300 + August 12, 1998

From Vital and Health Statistics of the CENTERS FOR DISEASE CONTROL AND 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
+ Frequently performed procedures on

ambulatory patients include extraction

of lens (2,367,000), endoscopy of

large intestine (1,913,000), insertion

of prosthetic lens (1,816,000), and

endoscopy of small intestine

(1,563,000) (table 4, figure 4).

+ Females had higher rates per 10,000

population than males for ambulatory

procedures such as release of carpal

tunnel (17.6 versus 9.3), operations

on eyelids (12.5 versus 9.3),

extraction (109.8 versus 68.4) and

insertion (82.8 versus 54.1) of lens,

tonsillectomy (16.2 versus 12.8),

endoscopy of small intestine (66.1

versus 51.9), laparoscopy (27.1 versus

4.3), laparoscopic cholecystectomy

(18.8 versus 5.2), and excision and

repair of bunion and other toe

deformity (17.6 versus 3.4)

(tables 5–6).

+ Males had higher rates per 10,000

population than females for some

ambulatory procedures including

myringotomy with insertion of tube

(24.4 versus 15.6), adenoidectomy

without tonsillectomy (6.5 versus

3.6), cardiac catheterization (23.1

versus 12.9), endoscopic polypectomy

of large intestine (24.6 versus 17.6),

repair of inguinal hernia (37.1 versus

4.0), cystoscopy (32.8 versus 20.8),

reduction of fracture (11.3 versus

6.8), arthroscopy of knee (27.7 versus

20.1), excision of semilunar cartilage

of knee (21.4 versus 13.3),

replacement or other repair of knee

(11.9 versus 8.3), and arteriography

and angiocardiography using contrast

material (37.0 versus 23.3).

+ Ambulatory procedures often

performed on children under 15 years

included myringotomy (490,000),

tonsillectomy (263,000),

adenoidectomy without tonsillectomy

(126,000), and operations on teeth,

gums, and alveoli (169,000).

Table 1. Number and rate of visits or discharges and procedures by type of patient: United States, 1996

Utilization measure

Total Ambulatory1 Inpatient2

Estimate

Standard

error Estimate

Standard

error Estimate

Standard

error

Number of visits or discharges in thousands3 ....... 40,132 1,114 20,838 861 19,294 707

Rate of visits or discharges per 1,000 population3 .... 152.0 4.2 78.9 3.3 73.1 2.7

Number of procedures in thousands ............. 71,904 2,106 31,507 1,323 40,397 1,638

Rate of procedures per 1,000 population .......... 272.4 8.0 119.3 5.0 153.0 6.2

1Data from the 1996 National Survey of Ambulatory Surgery.

2Data from the 1996 National Hospital Discharge Survey.

3Ambulatory 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, 1996

Table 2. Number and rate of ambulatory surgery visits and procedures, by type of facility: United States, 1996

Utilization measure

All facilities Hospitals

Freestanding

centers

Estimate

Standard

error Estimate

Standard

error Estimate

Standard

error

Number of visits in thousands ............... 20,838 861 17,524 799 3,313 282

Rate of visits per 1,000 population ............ 78.9 3.3 66.4 3.0 12.6 1.1

Number of procedures in thousands ........... 31,507 1,323 26,373 1,221 5,134 438

Rate of procedures per 1,000 population ........ 119.3 5.0 99.9 4.6 19.4 1.7

2 Advance Data No. 300 + August 12, 1998
+ A variety of ambulatory procedures

commonly performed on persons

15–44 years of age included

endoscopy of small intestine

(419,000), endoscopy of large

intestine (380,000), laparoscopy

(334,000), excision or destruction of

lesion or tissue of skin and

subcutaneous tissue (330,000),

arthroscopy of knee (325,000),

dilation and curettage of uterus

(318,000), and bilateral destruction or

occlusion of fallopian tubes

(314,000).

+ For persons 45–64 years of age,

endoscopy of large intestine

(696,000) and endoscopy of small

intestine (502,000) were frequent

ambulatory procedures.

+ Common ambulatory procedures for

persons 65 years of age and over

were extraction of lens (1,977,000),

insertion of prosthetic lens

(1,501,000), endoscopy of large

intestine (822,000), and endoscopy of

small intestine (614,000).

Diagnoses for Ambulatory Surgery

Visits

+ Diagnoses for 500,000 or more

ambulatory surgery visits included

cataract (2,328,000); benign

neoplasms (993,000), especially

benign neoplasm of colon (586,000);

malignant neoplasms (785,000);

rheumatism (616,000); and inguinal

hernia (515,000) (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

(17.2 versus 8.8), glaucoma (5.0

versus 3.0), cataract (108.2 versus

67.1), ulcer of stomach and small

intestine (5.0 versus 3.4), gastritis and

duodenitis (16.5 versus 10.9),

cholelithiasis (16.2 versus 4.5),

rheumatism, excluding back (26.8

versus 19.6), acquired deformities of

toe (10.2 versus 2.3), abdominal pain

(11.6 versus 5.0), and visit for

sterilization (22.1 versus 5.2)

(tables 8–9).

+ 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 (23.1

versus 14.9), heart disease (19.5

versus 11.4), deviated nasal septum

(6.5 versus 4.8), inguinal hernia (35.9

versus 3.9), calculus of kidney and

ureter (9.3 versus 5.1), fractures (13.8

versus 8.6), and current tear of

medial cartilage or meniscus of knee

(12.4 versus 7.0).

Introduction

This report presents data from the

1996 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 (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

after effects, 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

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

United States, 1996

Advance Data No. 300 + August 12, 1998 3
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

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 a decade

later (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 (5–7). 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. The NSAS was

undertaken to obtain information about

ambulatory procedures. For many types

of procedures, data from both the NHDS

and the NSAS are now required to

obtain national estimates. Reports that

present both ambulatory and inpatient

procedure data for 1994 and for 1995

have been published (8,9).

NSAS and NHDS are two of the

NCHS establishment surveys,

collectively called the National Health

Care Survey (NHCS). NHCS was

designed to provide nationally

representative data on the use of health

care resources for major sectors of the

health care delivery system. Information

on ambulatory procedures is also

collected in two other NHCS surveys.

The National Ambulatory Medical Care

Survey obtains information on

procedures ordered or performed during

visits to physicians’ offices (10), and the

National Hospital Ambulatory Medical

Care Survey collects data on procedures

ordered or performed during visits to

hospital outpatient and emergency

departments (11,12).

This report provides summary data

from the 1996 NSAS. For perspective,

the NSAS data on ambulatory

procedures in 1996 are compared with

estimates of inpatient procedures from

the 1996 NHDS (7) in table 1. Estimates

from the NSAS are presented for

hospitals and freestanding facilities

(table 2) and by patient age and sex and

by geographic region (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, the

NSAS was conducted for the first time

in 1994. Results for 1994 and 1995

have been published (13,14). This

survey covers surgical and nonsurgical

procedures performed on an ambulatory

basis in hospitals and freestanding

ambulatory surgery centers. The hospital

universe includes noninstitutional

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

and region: United States, 1996

[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.......................... 20,838 861 9,113 400 11,725 470

Age

Under 15 years ................... 1,754 98 1,036 59 718 43

15–44 years ..................... 6,329 294 2,417 122 3,913 178

45–64 years ..................... 5,756 259 2,612 126 3,144 139

65 years and over ................. 6,998 328 3,048 149 3,949 188

Region

Northeast ...................... 4,536 402 2,037 196 2,499 211

Midwest ....................... 5,295 405 2,321 194 2,974 214

South ......................... 6,865 560 2,887 241 3,978 324

West . . . . . . . . . . . . . . . . . . . . . . . . . 4,142 319 1,868 160 2,274 163

Percent distribution

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

Age

Under 15 years . . . . . . . . . . . . . . . . . . . 8.4 0.5 11.4 0.6 6.1 0.4

15–44 years ..................... 30.4 1.4 26.5 1.3 33.4 1.5

45–64 years ..................... 27.6 1.2 28.7 1.4 26.8 1.2

65 years and over ................. 33.6 1.6 33.5 1.6 33.7 1.6

Region

Northeast ...................... 21.8 1.9 22.4 2.2 21.3 1.8

Midwest ....................... 25.4 1.9 25.5 2.1 25.4 1.8

South ......................... 32.9 2.7 31.7 2.6 33.9 2.8

West . . . . . . . . . . . . . . . . . . . . . . . . . 19.9 1.5 20.5 1.8 19.4 1.4

Rate per 1,000 population

Total.......................... 78.9 3.3 70.8 3.1 86.7 3.5

Age

Under 15 years ................... 30.4 1.7 35.1 2.0 25.5 1.5

15–44 years ..................... 53.3 2.5 40.8 2.1 65.8 3.0

45–64 years ..................... 107.2 4.8 100.6 4.8 113.4 5.0

65 years and over ................. 206.7 9.7 219.6 10.7 197.7 9.4

Region

Northeast ...................... 88.0 7.8 81.9 7.9 93.8 7.9

Midwest ....................... 85.4 6.5 76.8 6.4 93.6 6.7

South ......................... 74.3 6.1 64.6 5.4 83.5 6.8

West . . . . . . . . . . . . . . . . . . . . . . . . . 71.3 5.5 64.6 5.5 77.8 5.6

. . . Category not applicable.

4 Advance Data No. 300 + August 12, 1998
hospitals exclusive of Federal, military,

and Department of Veterans Affairs

hospitals, located in the 50 States and

the District of Columbia. Only shortstay 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 (7). The sampling

frame for the hospital universe consists

of eligible hospitals listed in the 1993

SMG Hospital Market Database (15).

The universe of freestanding

facilities includes the freestanding

ambulatory surgery centers listed in the

1993 SMG Freestanding Outpatient

Surgery Center Database (16) and/or

Medicare-certified facilities included in

the Health Care Financing

Administration Provider-of-Services file

(17). Facilities specializing in dentistry,

podiatry, abortion, family planning, or

birthing are excluded. A detailed

description of the development and

operation of NSAS has been

published (18).

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 (19). 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. Because

NSAS data are collected from a sample

of visits, persons with multiple visits

during the year may be sampled more

than once. NSAS estimates are of the

number of visits to or procedures

performed in ambulatory surgery

facilities, not the number of persons

served by these facilities.

There were 751 hospitals and

freestanding ambulatory surgery centers

in the 1996 NSAS sample. Of these,

150 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 601 in-scope

(eligible) facilities, 488 responded to the

survey, for an overall response rate of

81 percent. The response rate was

91 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 1996

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) (20).

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

Figure 3. Rate of ambulatory surgery visits by age and sex: United States, 1996

Advance Data No. 300 + August 12, 1998 5
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 (21).

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

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 (10)

and the National Hospital Ambulatory

Medical Care Survey provides

information about procedures in hospital

outpatient and emergency departments

(11,12). 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,

but 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 (16)

and is selected into the NSAS sample

from this universe, it is considered a

freestanding facility. Additional

definitions of terms used in NSAS have

been published (18).

According to the 1996 NSAS, an

estimated 399,000 ambulatory surgery

visits with procedures were discharged

to inpatient status. Of these, 393,000

(98 percent) were visits to hospitals and

7,000 (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 these

procedures in both NSAS and NHDS,

these patients were excluded from the

data shown in this report, as they were

from the 1995 version of this report

(14). However, procedures for these

patients were included in the summaries

of outpatient procedures as described in

the first version of this report for

1994 (13).

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

United States, 1996

6 Advance Data No. 300 + August 12, 1998
Table 4. Number of ambulatory surgery procedures, by procedure category, sex, and age: United States, 1996

[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 ................................................ 31,507 13,883 17,624 2,381 9,561 8,825 10,740

Operations on the nervous system ................................ 01–05 1,240 496 744 11 465 462 302

Injection of agent into spinal canal........................... 03.91–03.92 534 224 310 * 166 199 169

Release of carpal tunnel ..................................... 04.43 358 120 238 * 132 142 84

Operations on the eye........................................ 08–16 5,306 2,076 3,230 137 264 877 4,027

Operations on eyelids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08 289 120 169 17 42 97 132

Extraction of lens ...................................... 13.1–13.6 2,367 881 1,486 * 46 331 1,977

Insertion of prosthetic lens (pseudophakos) .......................... 13.7 1,816 696 1,120 * 36 270 1,501

Operations on the ear ........................................ 18–20 841 484 357 636 102 60 42

Myringotomy with insertion of tube............................... 20.01 524 313 211 490 16 *11 *8

Operations on the nose, mouth, and pharynx ......................... 21–29 2,091 1,103 988 679 837 411 165

Turbinectomy ............................................. 21.6 161 90 71 14 101 38 *8

Repair and plastic operations on the nose ........................... 21.8 276 147 128 *9 170 75 22

Operations on nasal sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 463 229 234 33 223 163 43

Operations on teeth, gums, and alveoli ............................ 23–24 249 131 118 169 50 *19 *10

Tonsillectomy with or without adenoidectomy ..................... 28.2–28.3 383 164 219 263 109 *7 *

Adenoidectomy without tonsillectomy .............................. 28.6 132 83 49 126 *6 * *

Operations on the respiratory system .............................. 30–34 429 219 211 41 77 154 157

Bronchoscopy with or without biopsy ..................... 33.21–33.24,33.27 192 105 86 13 25 64 90

Operations on the cardiovascular system ............................ 35–39 898 525 372 * 139 362 384

Cardiac catheterization .................................. 37.21–37.23 472 298 175 * 47 206 213

Operations on the digestive system ............................... 42–54 6,888 3,141 3,747 186 2,079 2,211 2,413

Esophagoscopy and gastroscopy ................... 42.21–42.24,44.11–44.14 128 62 67 5 * 45 48

Dilation of esophagus ...................................... 42.92 241 107 134 * 38 75 123

Endoscopy of small intestine with or without biopsy ............ 45.11–45.14,45.16 1,563 668 895 28 419 502 614

Endoscopy of large intestine with or without biopsy ................ 45.21–45.25 1,913 855 1,058 15 380 696 822

Endoscopic polypectomy of large intestine.......................... 45.42 555 317 238 * 59 201 291

Laparoscopic cholecystectomy ................................. 51.23 321 67 254 * 151 120 48

Repair of inguinal hernia .................................. 53.0–53.1 531 477 54 75 165 146 146

Laparoscopy ............................................ 54.21 422 55 367 *7 334 63 18

Operations on the urinary system................................. 55–59 1,432 875 557 73 311 427 621

Cystoscopy with or without biopsy ........................... 57.31–57.33 703 422 281 26 137 205 336

Operations on the male genital organs ............................. 60–64 537 537 . . . 141 166 100 129

Operations on the female genital organs ............................ 65–71 1,962 . . . 1,962 12 1,444 381 124

Bilateral destruction or occlusion of fallopian tubes.................. 66.2–66.3 320 . . . 320 – 314 *7 *

Hysteroscopy............................................ 68.12 229 . . . 229 * 126 80 22

Dilation and curettage of uterus ................................. 69.0 530 . . . 530 * 318 160 51

Operations on the musculoskeletal system ........................... 76–84 4,226 2,179 2,047 162 1,965 1,468 631

Partial excision of bone ............................ 76.2–76.3,77.6–77.8 274 133 141 9 124 102 39

Reduction of fracture ................................. 76.7,79.0–79.3 236 145 91 55 117 42 22

Removal of implanted devices from bone ....................... 76.97,78.6 173 89 84 18 90 38 27

Excision and repair of bunion and other toe deformities................... 77.5 281 44 238 * 99 117 64

Arthroscopy of knee........................................ 80.26 629 357 272 9 325 212 83

Excision of semilunar cartilage of knee ............................. 80.6 455 275 180 * 198 178 76

Replacement or other repair of knee ................. 81.42–81.47,81.54–81.55 265 153 112 * 148 88 27

Operations on muscle, tendon, fascia, and bursa...................... 82–83 664 320 345 28 260 254 123

Operations on the integumentary system ............................ 85–86 2,389 678 1,711 120 893 829 547

Biopsy of breast ...................................... 85.11–85.12 307 *11 295 * 104 128 74

Local excision of lesion of breast (lumpectomy)....................... 85.21 341 12 329 * 127 130 81

Excision or destruction of lesion or tissue of skin and subcutaneous tissue. . . 86.2–86.4 877 412 465 71 330 258 217

Miscellaneous diagnostic and therapeutic procedures .................... 87–99 3,058 1,496 1,562 154 741 1,013 1,150

Arteriography and angiocardiography using contrast material ........... 88.4–88.5 791 476 316 *2 66 319 404

Injection or infusion of therapeutic or prophylactic substance ........... 99.1–99.2 464 203 260 * 135 165 155

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

and obstetrical procedures .......................... 06–07,40–41,72–75 210 72 137 15 77 71 47

* Figure does not meet standard of reliability or precison.

. . . 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. 300 + August 12, 1998 7
Table 5. Rate of ambulatory surgery procedures, by procedure category, sex, and age: United States, 1996

[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 ................................................ 1,193.4 1,078.8 1,302.5 412.6 805.2 1,643.5 3,171.9

Operations on the nervous system ................................ 01–05 47.0 38.6 55.0 1.9 39.2 86.1 89.2

Injection of agent into spinal canal........................... 03.91–03.92 20.2 17.4 22.9 * 14.0 37.1 49.9

Release of carpal tunnel ..................................... 04.43 13.6 9.3 17.6 * 11.1 26.4 24.7

Operations on the eye........................................ 08–16 201.0 161.3 238.7 23.7 22.3 163.4 1,189.2

Operations on eyelids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08 10.9 9.3 12.5 3.0 3.5 18.1 39.1

Extraction of lens ...................................... 13.1–13.6 89.6 68.4 109.8 * 3.9 61.7 584.0

Insertion of prosthetic lens (pseudophakos) .......................... 13.7 68.8 54.1 82.8 * 3.1 50.4 443.4

Operations on the ear ........................................ 18–20 31.8 37.6 26.4 110.2 8.6 11.1 12.5

Myringotomy with insertion of tube............................... 20.01 19.9 24.4 15.6 84.9 1.4 *2.0 *2.3

Operations on the nose, mouth, and pharynx ......................... 21–29 79.2 85.7 73.0 117.6 70.5 76.5 48.8

Turbinectomy ............................................. 21.6 6.1 7.0 5.3 2.5 8.5 7.0 *2.3

Repair and plastic operations on the nose ........................... 21.8 10.4 11.4 9.5 *1.5 14.3 14.0 6.5

Operations on nasal sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 17.5 17.8 17.3 5.7 18.8 30.4 12.8

Operations on teeth, gums, and alveoli ............................ 23–24 9.4 10.2 8.7 29.4 4.2 *3.6 *3.0

Tonsillectomy with or without adenoidectomy ..................... 28.2–28.3 14.5 12.8 16.2 45.6 9.2 *1.3 *

Adenoidectomy without tonsillectomy .............................. 28.6 5.0 6.5 3.6 21.8 *0.5 * *

Operations on the respiratory system .............................. 30–34 16.3 17.0 15.6 7.1 6.5 28.7 46.4

Bronchoscopy with or without biopsy ..................... 33.21–33.24,33.27 7.3 8.2 6.4 2.2 2.1 12.0 26.5

Operations on the cardiovascular system ............................ 35–39 34.0 40.8 27.5 * 11.7 67.4 113.3

Cardiac catheterization .................................. 37.21–37.23 17.9 23.1 12.9 * 4.0 38.4 62.9

Operations on the digestive system ............................... 42–54 260.9 244.1 276.9 32.2 175.1 411.7 712.6

Esophagoscopy and gastroscopy ................... 42.21–42.24,44.11–44.14 4.9 4.8 4.9 0.9 * 8.3 14.1

Dilation of esophagus ...................................... 42.92 9.1 8.3 9.9 * 3.2 14.0 36.3

Endoscopy of small intestine with or without biopsy ............ 45.11–45.14,45.16 59.2 51.9 66.1 4.8 35.3 93.6 181.3

Endoscopy of large intestine with or without biopsy ................ 45.21–45.25 72.5 66.5 78.2 2.7 32.0 129.7 242.7

Endoscopic polypectomy of large intestine.......................... 45.42 21.0 24.6 17.6 * 5.0 37.5 86.0

Laparoscopic cholecystectomy ................................. 51.23 12.2 5.2 18.8 * 12.8 22.4 14.2

Repair of inguinal hernia .................................. 53.0–53.1 20.1 37.1 4.0 13.0 13.9 27.2 43.0

Laparoscopy ............................................ 54.21 16.0 4.3 27.1 *1.2 28.1 11.7 5.3

Operations on the urinary system................................. 55–59 54.2 68.0 41.2 12.7 26.2 79.6 183.3

Cystoscopy with or without biopsy ........................... 57.31–57.33 26.6 32.8 20.8 4.5 11.5 38.2 99.1

Operations on the male genital organs ............................. 60–64 20.4 41.8 . . . 24.5 14.0 18.6 38.2

Operations on the female genital organs ............................ 65–71 74.3 . . . 145.0 2.1 121.6 71.0 36.7

Bilateral destruction or occlusion of fallopian tubes.................. 66.2–66.3 12.1 . . . 23.7 – 26.4 *1.2 *

Hysteroscopy............................................ 68.12 8.7 . . . 16.9 * 10.6 14.9 6.6

Dilation and curettage of uterus ................................. 69.0 20.1 . . . 39.2 * 26.8 29.8 15.0

Operations on the musculoskeletal system ........................... 76–84 160.1 169.3 151.3 28.1 165.5 273.4 186.5

Partial excision of bone ............................ 76.2–76.3,77.6–77.8 10.4 10.3 10.4 1.5 10.4 18.9 11.6

Reduction of fracture ................................. 76.7,79.0–79.3 9.0 11.3 6.8 9.5 9.9 7.9 6.6

Removal of implanted devices from bone ....................... 76.97,78.6 6.5 6.9 6.2 3.1 7.6 7.0 7.9

Excision and repair of bunion and other toe deformities................... 77.5 10.7 3.4 17.6 * 8.3 21.8 18.8

Arthroscopy of knee........................................ 80.26 23.8 27.7 20.1 1.6 27.4 39.5 24.5

Excision of semilunar cartilage of knee ............................. 80.6 17.2 21.4 13.3 * 16.7 33.1 22.5

Replacement or other repair of knee ................. 81.42–81.47,81.54–81.55 10.1 11.9 8.3 * 12.5 16.3 8.0

Operations on muscle, tendon, fascia, and bursa...................... 82–83 25.2 24.8 25.5 4.8 21.9 47.2 36.3

Operations on the integumentary system ............................ 85–86 90.5 52.7 126.4 20.8 75.2 154.3 161.4

Biopsy of breast ...................................... 85.11–85.12 11.6 *0.9 21.8 * 8.7 23.9 21.7

Local excision of lesion of breast (lumpectomy)....................... 85.21 12.9 0.9 24.3 * 10.7 24.3 24.1

Excision or destruction of lesion or tissue of skin and

subcutaneous tissue ................................... 86.2–86.4 33.2 32.0 34.4 12.4 27.8 48.1 64.1

Miscellaneous diagnostic and therapeutic procedures .................... 87–99 115.8 116.2 115.5 26.7 62.4 188.6 339.7

Arteriography and angiocardiography using contrast material ........... 88.4–88.5 30.0 37.0 23.3 *0.4 5.6 59.4 119.4

Injection or infusion of therapeutic or prophylactic substance ........... 99.1–99.2 17.6 15.8 19.2 * 11.3 30.8 45.8

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

and obstetrical procedures ......................... 06–07,40–41,72–75 7.9 5.6 10.1 2.5 6.5 13.1 13.9

* 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. 300 + August 12, 1998
Table 6. Relative standard errors for number and rate of ambulatory surgery procedures, by procedure category, sex, and age:

United States, 1996

[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 ................................................ 4.20 4.47 4.09 5.69 4.76 4.61 4.80

Operations on the nervous system ................................ 01–05 7.55 8.29 7.51 20.80 7.63 8.27 9.56

Injection of agent into spinal canal........................... 03.91–03.92 12.61 12.63 13.04 * 13.32 13.75 13.85

Release of carpal tunnel ..................................... 04.43 6.62 9.54 6.48 * 8.64 7.88 10.10

Operations on the eye........................................ 08–16 7.03 7.63 6.81 12.83 10.43 7.06 7.57

Operations on eyelids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08 8.91 9.26 10.30 18.11 14.14 17.18 9.17

Extraction of lens ...................................... 13.1–13.6 8.15 8.86 7.89 * 14.74 7.88 8.52

Insertion of prosthetic lens (pseudophakos) .......................... 13.7 6.80 7.72 6.53 * 16.00 7.49 7.04

Operations on the ear ........................................ 18–20 6.02 6.10 7.37 6.53 10.75 14.17 11.50

Myringotomy with insertion of tube............................... 20.01 6.56 6.87 7.65 6.74 16.88 *21.25 *26.93

Operations on the nose, mouth, and pharynx ......................... 21–29 6.09 6.73 6.33 6.87 6.63 10.16 10.88

Turbinectomy ............................................. 21.6 9.91 11.36 11.73 22.33 10.61 13.48 *22.01

Repair and plastic operations on the nose ........................... 21.8 7.08 8.22 8.23 *23.18 8.34 9.43 15.37

Operations on nasal sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 10.12 11.86 10.99 14.88 10.07 12.93 27.75

Operations on teeth, gums, and alveoli ............................ 23–24 13.42 13.57 14.84 16.10 22.83 *28.17 *27.55

Tonsillectomy with or without adenoidectomy ..................... 28.2–28.3 7.60 7.84 8.47 7.99 10.79 *27.56 *

Adenoidectomy without tonsillectomy .............................. 28.6 9.98 10.90 11.71 10.20 *24.78 * *

Operations on the respiratory system .............................. 30–34 8.59 9.94 8.92 20.82 11.43 10.84 11.95

Bronchoscopy with or without biopsy ..................... 33.21–33.24,33.27 11.00 13.79 10.68 22.60 22.55 13.58 13.95

Operations on the cardiovascular system ............................ 35–39 12.33 14.08 10.94 * 11.39 11.83 15.09

Cardiac catheterization .................................. 37.21–37.23 14.65 15.83 13.94 * 16.05 13.76 16.67

Operations on the digestive system ............................... 42–54 5.75 5.82 5.95 8.46 6.24 6.29 6.78

Esophagoscopy and gastroscopy ................... 42.21–42.24,44.11–44.14 19.58 18.41 22.80 24.81 * 20.33 24.38

Dilation of esophagus ...................................... 42.92 13.31 12.35 15.75 * 16.58 14.01 15.63

Endoscopy of small intestine with or without biopsy ............ 45.11–45.14,45.16 8.21 8.23 8.54 18.68 9.36 8.75 8.89

Endoscopy of large intestine with or without biopsy ................ 45.21–45.25 7.20 7.49 7.42 25.55 9.82 7.46 7.82

Endoscopic polypectomy of large intestine.......................... 45.42 9.50 10.82 8.88 * 21.61 9.51 9.87

Laparoscopic cholecystectomy ................................. 51.23 8.81 9.93 9.28 * 10.43 10.08 11.98

Repair of inguinal hernia .................................. 53.0–53.1 5.09 5.24 8.94 9.47 7.93 7.19 6.96

Laparoscopy ............................................ 54.21 7.82 15.21 8.09 *22.83 8.17 11.65 17.85

Operations on the urinary system................................. 55–59 7.60 7.15 9.39 13.95 8.97 8.44 8.81

Cystoscopy with or without biopsy ........................... 57.31–57.33 9.94 9.41 11.49 14.64 10.14 9.98 11.78

Operations on the male genital organs ............................. 60–64 7.20 7.21 . . . 8.56 12.35 9.52 8.87

Operations on the female genital organs ............................ 65–71 5.52 . . . 5.52 23.17 5.70 7.87 10.42

Bilateral destruction or occlusion of fallopian tubes.................. 66.2–66.3 8.14 . . . 8.14 – 8.16 *24.92 *

Hysteroscopy............................................ 68.12 9.40 . . . 9.40 * 10.62 10.47 17.68

Dilation and curettage of uterus ................................. 69.0 5.39 . . . 5.39 * 5.52 8.09 10.60

Operations on the musculoskeletal system ........................... 76–84 6.03 6.35 6.22 8.73 6.40 6.75 6.13

Partial excision of bone ............................ 76.2–76.3,77.6–77.8 8.21 8.71 9.94 22.08 9.99 10.95 10.30

Reduction of fracture ................................. 76.7,79.0–79.3 7.27 7.78 9.86 12.44 8.55 12.44 16.32

Removal of implanted devices from bone ....................... 76.97,78.6 8.03 10.29 8.99 16.20 10.49 12.35 13.08

Excision and repair of bunion and other toe deformities................... 77.5 9.62 12.66 10.17 * 11.29 13.56 11.09

Arthroscopy of knee........................................ 80.26 7.59 9.09 7.26 21.35 8.40 8.83 9.90

Excision of semilunar cartilage of knee ............................. 80.6 7.88 8.82 7.63 * 9.42 8.64 10.34

Replacement or other repair of knee ................. 81.42–81.47,81.54–81.55 8.24 9.03 9.81 * 9.32 10.92 13.72

Operations on muscle, tendon, fascia, and bursa...................... 82–83 6.22 6.36 7.44 13.25 7.17 7.20 7.21

Operations on the integumentary system ............................ 85–86 4.79 5.36 5.06 8.89 5.84 5.80 5.38

Biopsy of breast ...................................... 85.11–85.12 7.29 *24.30 7.17 * 9.18 8.49 10.04

Local excision of lesion of breast (lumpectomy)....................... 85.21 9.06 18.29 9.29 * 9.21 12.06 11.45

Excision or destruction of lesion or tissue of skin and subcutaneous tissue. . . 86.2–86.4 5.55 5.63 6.34 9.22 6.49 6.53 7.17

Miscellaneous diagnostic and therapeutic procedures .................... 87–99 7.85 8.52 7.77 9.20 9.44 8.39 8.56

Arteriography and angiocardiography using contrast material ........... 88.4–88.5 13.64 14.60 13.94 *26.42 16.25 13.56 14.90

Injection or infusion of therapeutic or prophylactic substance ........... 99.1–99.2 12.49 13.26 12.98 * 13.36 14.03 14.27

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

and obstetrical procedures ........................... 06–07,40–41,72–75 9.11 11.91 10.10 20.41 14.00 13.71 11.32

* Figure does not meet standard of reliability or precision.

. . . Category not appliable.

– 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. 300 + August 12, 1998 9
Table 7. Number of ambulatory surgery visits by first-listed diagnosis, sex, and age: United States, 1996

[Excludes ambulatory surgery patients admitted to hospitals as inpatients. Diagnositic 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 ................................................... 20,838 9,113 11,725 1,754 6,329 5,756 6,998

Infectious and parasitic diseases ..................................001–139 100 47 53 9 59 20 12

Neoplasms................................................140–239 1,885 863 1,022 54 354 659 818

Malignant neoplasms .................................. 140–208,230–234 785 351 434 * 106 279 389

Malignant neoplasm of skin........................... 172–173,176.0,198.2 167 90 77 * 18 56 93

Malignant neoplasm of breast ............................ 174–175,198.81 140 * 138 * 20 69 51

Benign neoplasms..........................................210–229 993 457 536 39 229 349 376

Benign neoplasm of colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211.3 586 324 261 * 57 225 301

Lipoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 109 50 60 * 40 45 24

Endocrine, nutritional and metabolic diseases, and immunity disorders...........240–279 147 56 92 * 46 56 41

Diseases of the nervous system and sense organs.......................320–389 4,041 1,645 2,396 597 399 693 2,351

Carpal tunnel syndrome ........................................354.0 346 113 233 * 127 136 82

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 107 39 68 * *8 22 73

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366 2,328 864 1,464 * 43 324 1,952

Otitis media and Eustachian tube disorders ..........................381–382 499 297 201 456 20 14 *8

Diseases of the circulatory system .................................390–459 927 513 415 * 175 362 381

Heart disease ....................391–392.0,393–398,402,404,410–416,420–429 405 251 155 * 30 162 208

Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 291 136 155 * 89 123 77

Diseases of the respiratory system .................................460–519 902 433 469 316 330 166 92

Deviated nasal septum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470 148 83 65 * 98 41 *8

Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473 126 59 67 11 59 47 *9

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474 365 163 203 268 94 * *

Diseases of the digestive system ..................................520–579 3,450 1,727 1,723 227 1,003 1,075 1,146

Diseases of teeth and supporting structures ..........................520–525 151 77 74 94 42 *10 *

Diseases of esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530 478 232 246 13 119 162 184

Ulcer of stomach and small intestine ..............................531–534 110 43 67 * 23 35 52

Gastritis and duodenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535 363 140 223 * 109 128 121

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 515 462 52 69 161 141 144

Noninfectious enteritis and colitis ................................555–558 136 69 67 * 61 43 29

Diverticula of intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562 342 152 190 * 14 102 225

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 277 58 219 * 126 104 45

Diseases of the genitourinary system ...............................580–629 2,257 668 1,589 112 977 668 499

Calculus of kidney and ureter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 189 120 69 * 72 72 44

Hematuria.................................................599.7 108 55 53 * 22 40 43

Benign mammary dysplasias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 148 * 148 * 56 66 26

Lump or mass in breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611.72 212 *13 199 * 84 76 51

Disorders of menstruation and other abnormal vaginal bleeding ..........626,627.0–627.1 252 . . . 252 * 119 100 33

Complications of pregnancy, childbirth, and the puerperium..................630–677 224 . . . 224 * 222 * –

Abortion and ectopic and molar pregnancy ..........................630–639 195 . . . 195 * 193 * –

Diseases of the skin and subcutaneous tissue..........................680–709 462 224 237 41 183 131 106

Sebaceous cyst .............................................706.2 105 57 48 *6 45 33 21

Diseases of the musculoskeletal system and connective tissue ...............710–739 2,022 849 1,172 35 844 733 410

Arthropathies and related disorders ...............................710–719 484 237 248 7 222 170 85

Internal derangement of knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 717 193 102 91 * 103 60 27

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 183 89 94 – 83 72 27

Lumbago .................................................724.2 136 58 78 * 41 56 38

Rheumatism, excluding back ...................................725–729 616 252 363 18 269 227 101

Acquired deformities of toe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 735 168 30 138 * 61 68 38

Congenital anomalies .........................................740–759 186 103 83 102 53 21 10

Symptoms, signs, and ill-defined conditions ...........................780–799 1,353 574 779 68 393 445 447

Abdominal pain .............................................789.0 221 65 156 * 91 72 49

Injury and poisoning ..........................................800–999 1,294 763 531 127 589 363 215

Fractures ...............................................800–829 294 178 116 70 146 52 27

Current tear of medial cartilage or meniscus of knee ......................836.0 253 159 94 * 107 107 38

Supplementary classification .................................... V01–V82 1,443 583 860 48 674 328 392

Visit for sterilization .......................................... V25.2 365 67 298 – 357 8 *

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

conditions originating in the perinatal period .............. 280–289,290–319,760–779 143 64 79 *3 28 35 77

* 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. 300 + August 12, 1998
Table 8. Rate of ambulatory surgery visits by first-listed diagnosis, sex, and age: United States, 1996

[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 ................................................... 789.3 708.1 866.5 304.0 533.1 1,072.0 2,066.6

Infectious and parasitic diseases ..................................001–139 3.8 3.6 3.9 1.5 4.9 3.8 3.5

Neoplasms................................................140–239 71.4 67.1 75.6 9.4 29.8 122.7 241.6

Malignant neoplasms .................................. 140–208,230–234 29.7 27.3 32.1 * 8.9 51.9 114.8

Malignant neoplasm of skin........................... 172–173,176.0,198.2 6.3 7.0 5.7 * 1.5 10.5 27.4

Malignant neoplasm of breast ............................ 174–175,198.81 5.3 * 10.2 * 1.7 12.9 15.0

Benign neoplasms..........................................210–229 37.6 35.5 39.6 6.8 19.3 65.0 111.0

Benign neoplasm of colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211.3 22.2 25.2 19.3 * 4.8 42.0 88.8

Lipoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 4.1 3.9 4.4 * 3.4 8.3 6.9

Endocrine, nutritional and metabolic diseases, and immunity disorders...........240–279 5.6 4.3 6.8 * 3.9 10.4 12.2

Diseases of the nervous system and sense organs.......................320–389 153.1 127.8 177.1 103.4 33.6 129.1 694.4

Carpal tunnel syndrome ........................................354.0 13.1 8.8 17.2 * 10.7 25.4 24.1

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 4.0 3.0 5.0 * *0.7 4.1 21.5

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366 88.2 67.1 108.2 * 3.6 60.4 576.5

Otitis media and Eustachian tube disorders ..........................381–382 18.9 23.1 14.9 79.0 1.7 2.7 *2.3

Diseases of the circulatory system .................................390–459 35.1 39.8 30.7 * 14.7 67.4 112.5

Heart disease ....................391–392.0,393–398,402,404,410–416,420–429 15.4 19.5 11.4 * 2.5 30.2 61.6

Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 11.0 10.6 11.4 * 7.5 23.0 22.6

Diseases of the respiratory system .................................460–519 34.2 33.7 34.7 54.7 27.8 30.8 27.0

Deviated nasal septum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470 5.6 6.5 4.8 * 8.2 7.7 *2.3

Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473 4.8 4.6 5.0 1.9 5.0 8.8 *2.7

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474 13.8 12.6 15.0 46.4 7.9 * *

Diseases of the digestive system ..................................520–579 130.7 134.2 127.4 39.4 84.5 200.2 338.3

Diseases of teeth and supporting structures ..........................520–525 5.7 6.0 5.5 16.3 3.5 *1.9 *

Diseases of esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530 18.1 18.1 18.2 2.2 10.0 30.3 54.4

Ulcer of stomach and small intestine ..............................531–534 4.2 3.4 5.0 * 2.0 6.4 15.4

Gastritis and duodenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535 13.7 10.9 16.5 * 9.2 23.7 35.8

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 19.5 35.9 3.9 11.9 13.6 26.2 42.4

Noninfectious enteritis and colitis ................................555–558 5.2 5.4 5.0 * 5.1 8.0 8.7

Diverticula of intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562 12.9 11.8 14.0 * 1.2 19.0 66.5

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 10.5 4.5 16.2 * 10.6 19.3 13.4

Diseases of the genitourinary system ...............................580–629 85.5 51.9 117.4 19.4 82.3 124.5 147.5

Calculus of kidney and ureter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 7.2 9.3 5.1 * 6.1 13.3 13.0

Hematuria.................................................599.7 4.1 4.3 3.9 * 1.8 7.5 12.8

Benign mammary dysplasias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 5.6 * 10.9 * 4.7 12.4 7.7

Lump or mass in breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611.72 8.0 *1.0 14.7 * 7.1 14.1 15.0

Disorders of menstruation and other abnormal vaginal bleeding.........626,627.0–627.1 9.6 . . . 18.6 * 10.0 18.6 9.9

Complications of pregnancy, childbirth, and the puerperium..................630–677 8.5 . . . 16.6 * 18.7 * –

Abortion and ectopic and molar pregnancy ..........................630–639 7.4 . . . 14.4 * 16.3 * –

Diseases of the skin and subcutaneous tissue..........................680–709 17.5 17.4 17.5 7.1 15.5 24.4 31.3

Sebaceous cyst .............................................706.2 4.0 4.5 3.6 *1.1 3.8 6.2 6.2

Diseases of the musculoskeletal system and connective tissue ...............710–739 76.6 66.0 86.7 6.1 71.1 136.5 121.2

Arthropathies and related disorders ...............................710–719 18.3 18.4 18.3 1.2 18.7 31.7 25.1

Internal derangement of knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 717 7.3 7.9 6.7 * 8.7 11.2 8.0

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 6.9 6.9 6.9 – 7.0 13.5 8.0

Lumbago .................................................724.2 5.2 4.5 5.8 * 3.5 10.5 11.3

Rheumatism, excluding back ...................................725–729 23.3 19.6 26.8 3.1 22.7 42.3 29.9

Acquired deformities of toe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 735 6.4 2.3 10.2 * 5.1 12.7 11.3

Congenital anomalies .........................................740–759 7.1 8.0 6.1 17.8 4.5 3.8 3.0

Symptoms, signs, and ill-defined conditions ...........................780–799 51.2 44.6 57.6 11.7 33.1 82.8 132.1

Abdominal pain .............................................789.0 8.4 5.0 11.6 * 7.7 13.3 14.6

Injury and poisoning ..........................................800–999 49.0 59.3 39.2 22.0 49.6 67.7 63.6

Fractures ...............................................800–829 11.1 13.8 8.6 12.1 12.3 9.6 8.0

Current tear of medial cartilage or meniscus of knee ......................836.0 9.6 12.4 7.0 * 9.0 19.8 11.4

Supplementary classification .................................... V01–V82 54.7 45.3 63.6 8.4 56.8 61.1 115.9

Visit for sterilization .......................................... V25.2 13.8 5.2 22.1 – 30.0 1.5 *

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

certain conditions originating in the perinatal period.......... 280–289,290–319,760–779 5.4 5.0 5.8 *0.6 2.4 6.6 22.6

* 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. 300 + August 12, 1998 11
Table 9. Relative standard errors for number and rate of ambulatory surgery visits, by first-listed diagnosis, sex, and age: United States,

1996

[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 ................................................... 4.13 4.39 4.01 5.60 4.64 4.50 4.69

Infectious and parasitic diseases ..................................001–139 9.49 12.30 11.62 20.08 12.38 14.74 25.10

Neoplasms................................................140–239 5.18 5.98 5.12 11.66 7.10 6.14 5.63

Malignant neoplasms .................................. 140–208,230–234 5.84 6.22 6.40 * 7.99 7.73 6.48

Malignant neoplasm of skin........................... 172–173,176.0,198.2 7.25 9.33 9.04 * 17.89 13.07 8.50

Malignant neoplasm of breast ............................ 174–175,198.81 9.11 * 9.02 * 13.94 11.99 12.52

Benign neoplasms..........................................210–229 6.99 8.80 6.23 10.13 9.06 7.84 8.56

Benign neoplasm of colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211.3 9.41 10.56 8.80 * 22.66 10.32 9.74

Lipoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 9.17 12.54 9.78 * 11.77 11.06 16.03

Endocrine, nutritional and metabolic diseases, and immunity disorders...........240–279 11.37 13.30 13.68 * 19.87 12.74 13.63

Diseases of the nervous system and sense organs.......................320–389 5.86 5.99 5.89 6.22 6.46 5.66 7.68

Carpal tunnel syndrome ........................................354.0 6.71 9.67 6.52 * 8.73 8.03 10.20

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 12.27 12.94 15.54 * *29.10 16.41 13.50

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366 8.19 8.91 7.93 * 15.45 7.85 8.56

Otitis media and Eustachian tube disorders ..........................381–382 6.50 6.79 7.61 6.66 14.83 23.34 *24.66

Diseases of the circulatory system .................................390–459 9.36 11.00 8.35 * 8.85 9.56 12.46

Heart disease ....................391–392.0,393–398,402,404,410–416,420–429 15.32 16.99 15.07 * 19.97 15.49 16.36

Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 8.45 9.13 10.02 * 11.99 9.16 12.69

Diseases of the respiratory system .................................460–519 6.31 6.82 6.37 7.94 7.07 7.85 12.07

Deviated nasal septum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470 8.24 9.80 9.96 * 9.31 12.33 *19.09

Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473 9.39 11.58 11.18 18.46 10.93 13.02 *28.73

Chronic disease of tonsils and adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474 8.35 8.59 9.08 8.53 12.15 * *

Diseases of the digestive system ..................................520–579 5.70 5.36 6.33 8.97 6.10 6.30 7.06

Diseases of teeth and supporting structures ..........................520–525 12.90 13.10 13.82 15.29 22.14 *24.18 *

Diseases of esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530 9.70 10.70 10.32 22.17 12.18 10.29 11.97

Ulcer of stomach and small intestine ..............................531–534 11.27 14.20 11.63 * 15.73 13.86 14.88

Gastritis and duodenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535 10.31 12.11 10.55 * 11.40 11.41 12.58

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 5.01 5.15 9.15 10.28 7.93 6.85 6.70

Noninfectious enteritis and colitis ................................555–558 12.30 16.76 12.01 * 14.40 13.77 20.82

Diverticula of intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562 9.37 10.37 10.17 * 19.97 10.60 9.80

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 8.85 9.54 9.46 * 11.00 10.54 10.35

Diseases of the genitourinary system ...............................580–629 5.07 6.39 5.30 8.99 5.69 5.54 6.66

Calculus of kidney and ureter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 9.10 10.09 10.70 * 10.64 10.13 12.89

Hematuria.................................................599.7 11.35 12.31 13.40 * 19.07 14.28 13.44

Benign mammary dysplasias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 12.88 * 12.97 * 13.19 17.02 16.68

Lump or mass in breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611.72 8.93 *23.32 8.91 * 10.60 11.27 14.46

Disorders of menstruation and other abnormal vaginal bleeding.........626,627.0–627.1 6.88 . . . 6.88 * 8.19 9.36 12.43

Complications of pregnancy, childbirth, and the puerperium..................630–677 7.38 . . . 7.38 * 7.42 * –

Abortion and ectopic and molar pregnancy ..........................630–639 7.56 . . . 7.56 * 7.60 * –

Diseases of the skin and subcutaneous tissue..........................680–709 6.48 6.76 7.91 13.78 7.23 9.59 8.50

Sebaceous cyst...............................................706.2 10.39 12.95 11.60 *21.26 14.23 13.70 16.19

Diseases of the musculoskeletal system and connective tissue ...............710–739 6.44 6.74 6.59 15.01 6.54 7.07 7.10

Arthropathies and related disorders ...............................710–719 7.52 7.92 8.08 20.48 8.22 8.81 10.09

Internal derangement of knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 717 9.51 10.56 10.60 * 10.10 13.15 17.08

Intervertebral disc disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 722 13.38 12.87 15.77 – 13.39 17.37 18.00

Lumbago .................................................724.2 16.10 17.49 16.78 * 17.72 16.12 21.37

Rheumatism, excluding back ...................................725–729 6.09 7.08 6.22 16.55 6.67 7.46 7.21

Acquired deformities of toe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 735 9.46 13.46 10.26 * 12.61 11.80 10.73

Congenital anomalies .........................................740–759 7.78 8.00 10.60 9.08 13.97 17.00 17.79

Symptoms, signs, and ill-defined conditions ...........................780–799 7.91 7.87 8.53 12.66 10.05 8.79 8.46

Abdominal pain .............................................789.0 13.94 14.84 14.82 * 15.81 16.29 16.31

Injury and poisoning ..........................................800–999 5.93 6.51 5.77 7.38 6.65 7.61 7.05

Fractures ...............................................800–829 6.83 7.14 9.65 9.86 8.03 12.03 14.01

Current tear of medial cartilage or meniscus of knee ......................836.0 9.79 11.11 10.15 * 11.21 11.82 14.51

Supplementary classification .................................... V01–V82 6.41 7.81 6.30 10.13 7.32 7.20 9.01

Admission for sterilization ...................................... V25.2 8.91 24.45 8.21 – 8.95 21.31 *

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

certain conditions originating in the perinatal period.......... 280–289,290–319,760–779 14.85 16.67 15.82 *29.14 18.99 17.52 19.69

* 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. 300 + August 12, 1998
Figure 5. Medical abstract for the National Survey of Ambulatory Surgery, 1996.

Advance Data No. 300 + August 12, 1998 13
Figure 5. Medical abstract for the National Survey of Ambulatory Surgery, 1996—Con.

14 Advance Data No. 300 + August 12, 1998
Because the NSAS sample was

drawn from the 1993 SMG and

Medicare Provider-of-Services lists,

facilities that began operating after 1993

are not included in the sampling frame.

For this reason, NSAS data probably

understates the total number of visits to

and procedures performed in hospitalbased and freestanding ambulatory

surgery facilities that were in operation

during 1996.

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, 1996. These

estimates were provided by the U.S.

Bureau of the Census and are consistent

with population estimates published in

Current Population Reports. Facilities

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

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

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.

References

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4. SMG Marketing Group, Inc.

Outpatient surgery centers exceed 3

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Hyattsville, Maryland: National

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the United States, 1994. Advance

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Ambulatory Surgery in the United

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15. SMG Marketing Group, Inc. Hospital

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18. McLemore T, Lawrence L. Plan and

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Ambulatory Surgery. National Center

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Tadros W. Design and estimation for

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Advance Data No. 300 + August 12, 1998 15
Suggested citation

Hall MJ and Lawrence L. Ambulatory surgery

in the United States, 1996. Advance data from

vital and health statistics; no. 300. Hyattsville,

Maryland: National Center for Health

Statistics. 1998.

Copyright information

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public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Director

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Deputy Director

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HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

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To receive this publication regularly, contact

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DHHS Publication No. (PHS) 98-1250

8-0702 (8/98)

20. Public Health Service and Health

Care Financing Administration.

International Classification of

Diseases, 9th Revision, Clinical

Modification. Washington: Public

Health Service. 4th ed. 1991.

21. Shah BV, Barnwell BG, Bieler GS.

SUDAAN User’s Manual: Software

for Analysis of Correlated Data,

Release 6.40. Research Triangle

Park, NC: Research Triangle

Institute. 1995.

16 Advance Data No. 300 + August 12, 1998

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