Changes in the General Surgical Workload, 1991-1999

HYPOTHESIS The volume and types of procedures performed by general surgeons have changed from 1991 to 1999. DATA SOURCE Medicare data from 1991 through 1999. METHODS Procedures from the Medicare database were defined as "general surgical" if the yearly volume performed by general surgeons exceeded 1000 cases. These procedures were divided into major and minor procedures. The total volume performed by all surgeons and the volume of cases performed by general surgeons were tabulated for each procedure. Procedures were also grouped into families. For major surgery, representative procedures with the highest volumes were selected for each family. For minor surgery, multiple high-volume procedures within families were selected and analyzed. RESULTS The volumes for each major surgical family were totaled. Although the volume of representative major general surgical procedures performed by all surgeons rose by 17 544 cases, the volume performed by general surgeons decreased by 8846 cases (1.8%). The total and general surgical volumes for cholecystectomy and appendectomy increased, but the volumes for breast surgery, hernia repair, splenectomy, and colon resection decreased. The total volume increased but the general surgical volume decreased for vascular surgery, pulmonary surgery, and major amputations. CONCLUSIONS From 1991 to 1999, there has been a decrease in the volume of major procedures performed by general surgeons. Part of this loss relates to reduced general surgical involvement in subspecialty surgery, but there were also reductions in colon surgery, breast surgery, hernia repairs, and splenectomy. The volume of appendectomies and cholecystectomies increased. The volume of minor procedures performed by general surgeons increased slightly, with gains in vascular and endoscopic surgery.Arch Surg. 2003;138:417-426-->