Treatments - My Operation? Let Me Tell You…

What are the most common operations — and what has changed over the last ten years? The graphic attempts to answer this question. In 2000 we underwent nearly 40 million operations. Ten years earlier, the number was just over 40 million. During that period, our population grew by 32.7 million people. We are having fewer operations — and we are possibly suffering less. Some trends are discernible, but let's first take a closer look at these data.

The largest number of operations in 1990 and again in 2000 took place in connection with childbirth — possibly the most complex and miraculous event in human biological experience. Rankings for other categories are somewhat different between 1990 and 2000, however. Operations on the musculoskeletal system, female genital organs, and the respiratory system, have retained their ranks — 4th, 5th, and 8th respectively. Others have shifted in rank.

Most notably, perhaps, two changes should be noted — and are marked with stars in the graphic. Cardiovascular operations are second in rank in 2000, displacing operations on the digestive system. Much of this change is due to an increase in catheterization — used for diagnosis — and procedures for removing obstructions (similar to catheterization) including use of the newly invented stents. Stents are tiny metallic inserts that keep arteries open in the heart. Catheterization is a process whereby the doctor can enter a beating heart using a wire (inserted in the thigh region) and examine the "environment."

Operations on the male genital organs have dropped in rank from 10th to 12th place — largely because of a drop in prostatectomy (prostate removal). This may be due to improvements in the detection of prostate cancer and experience gained in how to manage the disease, which has a very slow progression.

When we look at operations in detail — rather than by major groupings — we note that the single most common operation is a catheterization, mentioned earlier. This is a straw in the wind, as it were, because it signals the rise of procedures that will be less and less invasive (no large incisions, no bones sawed). As our ability to look inside the body with lasers and to manipulate miniaturized instruments by tiny motors increases, operations will change in character.

The third rank in specific procedures also goes to the cardiac category — angioplasty and stent insertion — also non-invasive procedures. The second most common operation is the mending of tissues cut during childbirth — repair of obstetric lacerations. The fourth-ranked procedure belongs to obstetrics as well. This is episiotomy. In some cases of difficult birth (944,000 such difficult cases took place in 2000), the vagina must be cut so that the baby will not tear the tissue as it comes out or is extracted. The cut is sewed up after the baby is delivered. To round out this ranking, the fifth most common operation is endoscopy of the small intestine. And endoscope is a device inserted through the anus to look at the small intestine from inside the body. A biopsy may be performed as part of an endoscopy. The 6th ranking procedure is the famous Cesarean section. The 7th is also obstetrical — the artificial rupture of membranes to aid the birthing process. It looks as if the delivery room and the heart have it.

Trends in operations reflect changes in society. A down-turn in deaths from heart disease appears to have its reflection in more — but less invasive — cardiac operations. Better methods of disease detection or screening have their echoes in the operating room.

Let us end with some glossary notes. "Hemic and lymphatic system" refers to the blood circulating system and the lymph nodes. Lymph nodes return water and protein from tissues back to the blood stream. The "pharynx" is the throat. The "endocrine" system, as MEDLINEplus defines it, consists of "glands that produce and secrete hormones into the blood or lymph systems. These glands include the thyroid, parathyroid, hypothalamus, pineal, pituitary, adrenal, islands of Langerhans in the pancreas, and the gonads (testes and ovaries). The effects of these hormones may affect one organ or tissue, or the entire body." The "integumentary system" includes the skin, hair, nails, and the sweat and oil glands.

Source: 2000 National Hospital Discharge Survey, Advanced Data from Vital and Health Statistics, Number 329, June 19, 2002. 1990 data from National Hospital Discharge Survey: Annual Summary, 1990, Series 13, Number 113. Vital and Health Statistics, U.S. Department of Health and Human Services. MEDLINEplus quote taken from http://www.nlm.nih.gov/medlineplus/ency/article/002351.htm.