The Increasing Workload of General Surgery

Background: With the aging of the baby boomers, individuals aged 65 years and older make up the fastest-growing segment of the US population. This aging of the population will lead to new challenges for the US health care system because older individuals are the largest consumers of health care. Hypothesis: The general surgery workload will increase dramatically by 2020 as a result of the aging population. Data Sources: The National Hospital Discharge Survey, National Survey of Ambulatory Surgery, US Census Bureau, and Centers for Medicare and Medicaid Services. Setting: A nationally representative random sample of inpatient and outpatient general surgical operations performed in 1996 in the United States. Methods: Age- and procedure-specific rates of general surgery were obtained from the National Hospital Discharge Survey and National Survey of Ambulatory Surgery. Population projections were derived from the census bureau. We used relative-value units as a proxy for surgical work. By linking these 3 data sources, we predicted the future general surgery workload by analyzing the rates of surgery and modeling both the aging and expansion of the population. Results: General surgery operations (n=63) were classified into 5 procedure categories. Whereas the population will grow by 18% between 2000 and 2020, the work-load of general surgeons will increase by 31.5%. The amount of growth (19.9%-40.3%) varies among different categories of operations. Conclusions: To our knowledge, this is one of the only studies to analyze the future workload of general surgery. We project a dramatic increase in workload in the next 20 years, largely as a result of the aging US population. Our baseline assumptions are relatively conservative, so this forecast may be an underestimation. Hence, the challenge for general surgeons is to develop strategies to address this problem while maintaining quality of care for our patients.