Vascular Procedures and Population Trends Predict Future Workload

New training plans will educate medical students the value of being a vascular surgeon

Newswise — CHICAGO–Vascular surgeons from the Washington University in St. Louis School of Medicine's section of vascular surgery have analyzed population and inpatient vascular procedure trends in the United States. The research also predicted the future demand for vascular surgeons and training in the specialty. Details of their findings and full statistical analysis have been published in the May issue of the Journal of Vascular Surgery®.
The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was queried to determine the weighted national estimates of inpatient vascular procedures performed on adult patients (age 18 and older) between 1997 and 2008. Using population estimates from the U.S. Census Bureau, the per capita rates of inpatient procedures were calculated for age-specific groups (18 to 64 years, 65 to 84 years and 85 years and older). The change in per capita rates along with population forecasts were used to predict future workload.
“There was a net increase (22 percent) of inpatient vascular procedures,” said co-author and vascular surgeon Jeffrey Jim, MD. “The total was 971,046 in 1997 which grew to 1,188,332 in 2008.” During the same time period, added Dr. Jim, the adult population increased by 16 percent from 198 to 230 million. The age-stratified per capita rates of all vascular procedures were + 21 percent for age 18 to 64; -4 percent for age 65 to 84; and +18 percent for patients older than 85 years.
A net increase of 5 percent (490 to 515 procedures per 100,000 capita) was calculated in the per capita rate for all adults. The study notes that based on the assumption that trends in age-specific rates remain constant there is a predicted inpatient workload increase of 18 percent by 2015; 34 percent by 2020; and 72 percent by 2030.

Cardiovascular disease remains the leading cause of death and morbidity for the elderly. The prevalence of this disease process has increased at a rate of 1 percent to 2 percent annually. Age is a significant risk factor for cardiovascular disease and this growth is expected to continue for the next few decades partially because a large wave of population density that comes from the aging baby boom generation. Moving forward from 2010, the American Heart Association reports that there will be an additional 27 million people with hypertension, 8 million with coronary artery disease, 4 million with stroke and 3 million with heart failure in 2030.
It is predicted that there will be 1.6 million vascular procedures in the adult population by 2020 and just over 2 million by the year 2030. By 2040 procedures will more than double from the documented rates in 2008 to well over 2.4 million. “While we used an expected increase of 5 percent in the per capita rates of vascular procedures, the driving force in this predicted increase is the several fold higher predicted growth in the population,” said Dr. Jim.
“The increasing vascular workload will need to be carefully evaluated, and training of additional physicians implemented, to assure that quality vascular care can be provided in the future,” added Dr. Jim. “Currently there is a cap which limits the number of postgraduate training positions. Vascular surgery continues to be the specialty with the lowest number of active physicians. Data from 2007 showed that there were 2,610 active vascular surgeons with only 2,392 that participated in patient care (others were participating in teaching, research or administration). More than one-third (971 of 2,610) of active vascular surgeons are 55 or older, getting closer to retirement age. Population data estimated that there were 115,564 people per active vascular surgeon, by far the largest number of all the specialties.”
To address the workforce shortage, a potential solution is to increase the number of fellowship-trained vascular surgeons, including women and minorities. There has been a significant growth in the number of training positions (from 56 in 1989 to 120 in 2009) over the past two decades. Despite this, there is still a failure to meet the estimated minimum of 160 vascular graduates needed each year for the expected demand in 2030.
Researchers estimate that it will cost more than $1 billion to train enough vascular surgeons by 2030. Even if the financial restraints are eliminated, there remains a limitation in the number of candidates that apply to vascular surgery. In eight of the past ten years, there were fewer applicants than available training positions.
“In addition to vascular surgeons, many other specialties (including cardiovascular disease specialists, general surgeons, interventional radiologists, and others) also perform vascular procedures,” added Dr. Jim. “Some general surgeons have performed vascular operations in relatively large numbers. As it stands now, vascular surgeons only perform a fraction of the vascular procedures in this country. Medicare and state database information shows that vascular surgeons perform approximately 70 percent all endovascular aneurysm repairs and 30 percent of peripheral stents and carotid stents.”

The Surgical Council on Resident Education has developed a general surgery residency curriculum outline that does not expect the future general surgeon to be able to provide comprehensive management of most vascular problems. To increase the number of accredited fellowship-trained positions leaders in vascular surgery must make training a priority.
Over the past decade there has been a decrease in the ratio of inpatient vs. outpatient interventions in an ambulatory surgery setting. The authors believe it is important to keep in mind that the observed trends and the calculated projections likely provide a significant underestimation of the overall future volume. Even with the intended underestimation, they still predict a significant future increase in vascular workload.
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About Journal of Vascular Surgery®Journal of Vascular Surgery® provides vascular, cardiothoracic and general surgeons with the most recent information in vascular surgery. Original, peer-reviewed articles cover clinical and experimental studies, noninvasive diagnostic techniques, processes and vascular substitutes, microvascular surgical techniques, angiography and endovascular management. Special issues publish papers presented at the annual meeting of the Journal's sponsoring society, the Society for Vascular Surgery®. Visit the Journal Web site at http:www.jvascsurg.org/.

About the Society for Vascular Surgery®The Society for Vascular Surgery® (SVS) is a not-for-profit professional medical society, composed primarily of vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. SVS is the national advocate for 3,350 specialty-trained vascular surgeons and other medical professionals who are dedicated to the prevention and cure of vascular disease. Visit its Web site at www.VascularWeb.org® and follow SVS on Facebook and Twitter.