Inpatient Surgery Data And Procedures Explained With Visuals
Data for the U.S.
- Total number of procedures performed: 51.4 million
- Number of selected procedures performed:
- Arteriography and angiocardiography using contrast material: 2.4 million
- Cardiac catheterizations: 1.0 million
- Endoscopy of small intestine with or without biopsy: 1.1 million
- Endoscopy of large intestine with or without biopsy: 499,000
- Diagnostic ultrasound: 1.1 million
- Balloon angioplasty of coronary artery or coronary atherectomy: 500,000
- Hysterectomy: 498,000
- Cesarean section:1.3 million
- Reduction of fracture: 671,000
- Insertion of coronary artery stent: 454,000
- Coronary artery bypass graft: 395,000
- Total knee replacement: 719,000
- Total hip replacement: 332,000
So you want to work in surgery? Better learn about the most frequently performed procedures. Here, I will give a brief explanation of what the procedure is and why it is most commonly preformed. As well as provide videos/pictures to aid in visualization. I am so passionate about surgery and feel like the information is out there for everyone to be educated on these procedures if they feel the need. After this post, you will be more well-rounded in your surgical knowledge and hopefully obtain a better understanding of the surgical procedure itself. Shall we begin?
Angiocardiography is a technique for radiographic examination of the heart chambers and thoracic veins and arteries. A liquid radiocontrast agent, typically containing iodine, is injected into the bloodstream, then the tissues are examined using X-rays. To avoid dilution, the radiopaque material is typically introduced with a catheter, a process known as selective angiocardiography. The X-ray image is normally captured on high speed serial media that allows the motion to be observed, such as 35mm film. The process requires fasting before the test, with a sedative and an antihistamine being administered before the test
Procedure: A catheter is introduced in to the artery in either radial artery or in femoral artery then the caterter is guided in to the heart chamber by moving it across the artery. A contrast medium is then introduced to the specific part through the catheter and during which a series of images are produced. Angiocardiography can be used to detect and diagnose congenital defects in the heart and adjacent vessels. The use of angiocardiography has declined with the introduction ofechocardiography. However, angiocardiography is still in use for selected cases as it provides a higher level of anatomical detail than echocardiography.
Cardiac catheterization is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes. Subsets of this technique are mainly coronary catheterization, involving the catheterization of the coronary arteries, and catheterization of cardiac chambers and valves of the Cardiac System.
Procedure: Cardiac catheterization is a medical procedure used to diagnose and treat some heart conditions. A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin, or neck and threaded to your heart. Through the catheter, your doctor can do diagnostic tests and treatments on your heart. For example, your doctor may put a special type of dye in the catheter. The dye will flow through your bloodstream to your heart. Then, your doctor will take x-ray pictures of your heart. The dye will make your coronary (heart) arteries visible on the pictures. The dye can show whether a waxy substance called plaque (plak) has built up inside your coronary arteries. Plaque can narrow or block the arteries and restrict blood flow to your heart. The buildup of plaque in the coronary arteries is called coronary heart disease (CHD) or coronary artery disease. Doctors also can use ultrasound during cardiac catheterization to see blockages in the coronary arteries. Ultrasound uses sound waves to create detailed pictures of the heart’s blood vessels. Doctors may take samples of blood and heart muscle during cardiac catheterization or do minor heart surgery. Cardiologists usually do cardiac catheterization in a hospital. You’re awake during the procedure, and it causes little or no pain. However, you may feel some soreness in the blood vessel where the catheter was inserted.
In small bowel biopsy, a tissue sample is extracted from the small intestine, or small bowel, and sent to a laboratory for analysis. To obtain the sample, you must swallow a capsule attached to a long, thin polyethylene tube; when it reaches the small intestine, suction is applied to pull the tissue specimen into the capsule. This method permits biopsies from areas that are out of reach via esophagogastroduodenoscopy and allows for larger samples to be obtained.
Purpose: To assist in the diagnosis of diseases of the intestinal lining, such as bacterial infections that cause diarrhea and malabsorption of nutrients. And to diagnose diseases of the small intestines. Your doctor may suggest this for you if you have already gotten an x-ray and received abnormal results, if you have otherwise unexplained diarrhea or gastrointestinal bleeding or if you have tumors in your small intestine.
With the procedure known as gastrointestinal endoscopy, a doctor is able to see the inside lining of your digestive tract. This examination is performed using an endoscope-a flexible fiberoptic tube with a tiny TV camera at the end. The camera is connected to either an eyepiece for direct viewing or a video screen that displays the images on a color TV. The endoscope not only allows diagnosis of gastrointestinal (GI) disease but treatment as well.
Reasoning for procedure: Doctors do have other diagnostic tests besides GI endoscopy, including echography to study the upper abdomen and a barium enema and other x-ray exams that outline the digestive tract. Doctors can study the stomach juices, stools, and blood to learn about GI functions. But none of these tests offers a direct vision of the mucous lining of the digestive tube.
Diagnostic sonography (ultrasonography) is an ultrasound-based diagnostic imaging technique used for visualizing internal body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions. The practice of examining pregnant women using ultrasound is called obstetric sonography, and is widely used. In physics, ‘ultrasound' refers to sound waves with a frequency too high for humans to hear. Ultrasound images (sonograms) are made by sending a pulse of ultrasound into tissue using an ultrasound transducer (probe). The sound reflects (echoes) from parts of the tissue; these echoes are recorded and displayed as an image to the operator.
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Fat and cholesterol accumulates on the inside of arteries (atherosclerosis). The small arteries of the heart muscle (the coronary arteries) can be narrowed or blocked by this accumulation. If the narrowing is small, percutaneous transluminal coronary angioplasty, or PTCA for short, may be the course for treatment. PTCA is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. The indications for PTCA are:
- Persistent chest pain (angina)
- Blockage of only one or two coronary arteries
While the patient is awake and pain-free (local anesthesia), a catheter is inserted into an artery at the top of the leg (the femoral artery). The procedure begins with the doctor injecting some local anesthesia into the groin area and putting a needle into the femoral artery (the blood vessel that runs from the heart down the leg). Once the needle is inserted, a guide wire is placed through the needle, into the blood vessel. Following this step, the guide wire is left in the blood vessel and the needle is removed. A large needle called an introducer is then placed over the guide wire and the guide wire is removed. Next, a diagnostic catheter, which is a long narrow tube, is advanced through the introducer over a .035”guidewire, into the blood vessel. This catheter is then guided to the aorta and the guidewire is removed. Once the catheter is placed in the opening or ostium of one of the coronary arteries, the doctor injects dye and takes a series of X-rays (film of the images). The first catheter is exchanged out over the guidewire for a guiding catheter and the guidewire is removed. A smaller guidewire is advanced across the blocked section of the coronary artery and a balloon -tipped tube is positioned so the balloon part of the tube is beside the blockage. The balloon is then inflated for a few seconds to compress the blockage against the artery wall. Then the balloon is deflated. The doctor may repeat this a few times, each time pumping up the balloon a little more to widen the passage for the blood to flow through. This treatment may be repeated at each blocked site in the coronary arteries. A device called a stent may be placed. A stent is a latticed, metal scaffold that is placed within the coronary artery to keep the vessel open. Once the catheter has been positioned at the coronary artery origin, contrast media is injected and a series of X-rays (film) are taken to check for any change in the arteries. Following this, the catheter is removed and the procedure is completed. This procedure can greatly improve the blood flow through the coronary arteries and to the heart tissue in about 90% of patients and may eliminate the need for coronary artery bypass surgery. The outcome is relief from chest pain symptoms and an improved exercise capacity. In 2 out of 3 cases, the procedure is considered successful with complete elimination of the narrowing or blockage. This procedure treats the condition but does not eliminate the cause and recurrences happen in 1 out of 3 to 5 cases. Patients should consider diet, exercise, and stress reduction measures. If adequate widening of the narrowing is not accomplished, heart surgery (coronary artery bypass graft surgery, also called a CABG) may be recommended. Immediately after the procedure, a ten-pound sandbag may be placed over the femoral artery puncture site in the leg and remain there for 6 hours. This is done to help the artery heal.
A hysterectomy is an operation to remove a woman’s uterus. A woman may have a hysterectomy for different reasons, including:
- Uterine fibroids that cause pain, bleeding, or other problems
- Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
- Cancer of the uterus, cervix, or ovaries
- Abnormal vaginal bleeding
- Chronic pelvic pain
- Adenomyosis, or a thickening of the uterus
There are two approaches to surgery – a traditional or open surgery and surgery using a minimally invasive procedure or MIP.
An abdominal hysterectomy is an open surgery. This is the most common approach to hysterectomy, accounting for about 65% of all procedures. To perform an abdominal hysterectomy, a surgeon makes a 5- to 7-inch incision, either up-and-down or side-to-side, across the belly. The surgeon then removes the uterus through this incision. On average, a woman spends more than three days in the hospital following an abdominal hysterectomy. There is also, after healing, a visible scar at the location of the incision.
There are several approaches that can be used for an MIP hysterectomy:
- Vaginal hysterectomy: The surgeon makes a cut in the vagina and removes the uterus through this incision. The incision is closed, leaving no visible scar.
- Laparoscopic hysterectomy: This surgery is done using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the belly or, in the case of a single site laparoscopic procedure, one small cut made in the belly button. The surgeon performs the hysterectomy from outside the body, viewing the operation on a video screen.
- Laparoscopic-assisted vaginal hysterectomy: Using laparoscopic surgical tools, a surgeon removes the uterus through an incision in the vagina.
- Robot-assisted laparoscopic hysterectomy: This procedure is similar to a laparoscopic hysterectomy, but the surgeon controls a sophisticated robotic system of surgical tools from outside the body. Advanced technology allows the surgeon to use natural wrist movements and view the hysterectomy on a three-dimensional screen.
Using an MIP approach to remove the uterus offers a number of benefits when compared to the more traditional open surgery used for an abdominal hysterectomy. In general, an MIP allows for faster recovery, shorter hospital stays, less pain and scarring, and a lower chance of infection than does an abdominal hysterectomy. With an MIP, women are generally able to resume their normal activity within an average of three to four weeks, compared to four to six weeks for an abdominal hysterectomy. And the costs associated with an MIP are considerably lower than the costs associated with open surgery, depending on the instruments used and the time spent in the operating room. Robotic procedures, however, can be much more expensive. There is also less risk of incisional hernias with an MIP. Not every woman is a good candidate for a minimally invasive procedure. The presence of scar tissue from previous surgeries, obesity, and health status can all affect whether or not an MIP is advisable.
A Cesarean section is a surgical procedure in which one or more incisions are made through a mother’s abdomen and uterus to deliver one or more babies. The first modern Cesarean section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881. A Cesarean section is often performed when a vaginal delivery would put the baby’s or mother’s life or health at risk. Some are also performed upon request without a medical reason to do so, which is a practice health authorities would like to reduce. C-sections result in a small overall increase in bad outcomes in low risk pregnancies. The bad outcomes that occur with C-section differ from those that occur with vaginal delivery. Established guidelines recommend that caesarean sections not be used before 39 weeks without a medical indication to perform the surgery.
Reduction is a surgical procedure to restore a fracture or dislocation to the correct alignment. This sense of the term “reduction” does not imply any sort of removal or quantitative decrease but rather implies a restoration: re (“back [to normal]”) + ducere (“lead”/”bring”), i.e., “bringing back to normal.” When a bone fractures, the fragments lose their alignment in the form of displacement or angulation. For the fractured bone to heal without anydeformity the bony fragments must be re-aligned to their normal anatomical position. Orthopedic surgery attempts to recreate the normal anatomy of the fractured bone by reduction of the displacement. Reduction could be by “closed” or “open” methods. Open reduction refers to the method wherein the fracture fragments are exposed surgically by dissecting the tissues. Cosed reduction refers to manipulation of the bone fragments without surgical exposure of the fragments.Because the process of reduction can briefly be intensely painful, it is commonly done under a short-acting anaesthetic, sedative, or nerve block. Once the fragments are reduced, the reduction is maintained by application of casts, traction or held by plates, screws, or other implants which may in turn be external or internal. It is very important to verify the accuracy of reduction by clinical tests and x-ray, especially in the case with joint dislocations.
(Not going to go into too much detail here, just advancing on the previous) Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. These blood vessels are called the coronary arteries. A coronary artery stent is a small, metal mesh tube that expands inside a coronary artery. A stent is often placed during or immediately after angioplasty. It helps prevent the artery from closing up again. A drug-eluting stent has medicine embedded in it that helps prevent the artery from closing in the long term.
Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease (CHD). CHD is a disease in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina. If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries. CABG is one treatment for CHD. During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new path for oxygen-rich blood to flow to the heart muscle. Surgeons can bypass multiple coronary arteries during one surgery.
The goals of CABG may include:
- Improving your quality of life and reducing angina and other CHD symptoms
- Allowing you to resume a more active lifestyle
- Improving the pumping action of your heart if it has been damaged by a heart attack
- Lowering the risk of a heart attack (in some patients, such as those who have diabetes)
- Improving your chance of survival
A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial material. The knee is a hinge joint which provides motion at the point where the thigh meets the lower leg. The thighbone (or femur) abuts the large bone of the lower leg (tibia) at the knee joint. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a channeled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic “button” may also be added under the kneecap surface. The artificial components of a total knee replacement are referred to as the prosthesis.
A total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint is surgically replaced with artificial materials. The normal hip joint is a ball and socket joint. The socket is a “cup-shaped” component of the pelvis called the acetabulum. The ball is the head of the thighbone (femur). Total hip joint replacement involves surgical removal of the diseased ball and socket and replacing them with a metal (or ceramic) ball and stem inserted into the femur bone and an artificial plastic (or ceramic) cup socket. The metallic artificial ball and stem are referred to as the “femoral prosthesis” and the plastic cup socket is the “acetabular prosthesis.” Upon inserting the prosthesis into the central core of the femur, it is fixed with a bony cement called methylmethacrylate. Alternatively, a “cementless” prosthesis is used that has microscopic pores which allow bony ingrowth from the normal femur into the prosthesis stem. This “cementless” hip is felt to have a longer duration and is considered especially for younger patients.