The number of surgical procedures performed in the United States (U.S.) in 2004 was approximately 28.5 million.  Due to the aging population and the baby boomer generation leading more active lives, and as more people become injured in sports activities as well as suffer from a lifetime of wear and tear, and due to innovative technology that allows for elective surgery, the number of these procedures is expected to continue on an upward trend.  In the year 2012, it is expected that the total number of surgical procedures performed in the U.S. will reach more than 38.0 million.

This dynamic report from Medtech Insight features U.S. surgical procedure volumes as well as an overview of each procedure, the etiology and epidemiology for selected diseases and disorders, surgical trends, and emerging surgical treatments.  The surgical procedures covered by this report include those in the following categories:  cardiovascular and thoracic, cosmetic, general, gynecologic and obstetric, major organ and tissue transplantation, ophthalmic, orthopedic and spinal, urologic, and miscellaneous. 

Covered topics in this report include abdominal and bariatric surgery; aneurysm and myocardial repair; appendectomy; arrhythmia and circulatory disorders; bone marrow and organ transplantation; breast and organ biopsy; cardiac device implantation; cataract, glaucoma, and refractive surgery; ear, nose, and throat procedures; fracture repair and bone grafts; hysterectomy; incontinence management; infertility diagnostic procedures; inguinal herniorrhaphy; joint arthroscopy and replacement; mastectomy; nephrectomy; plastic surgery; prostatic procedures; splenectomy; stone removal; strabismus correction; and vitrectomy.

TABLE OF CONTENTS AND LIST OF EXHIBITS

EXECUTIVE SUMMARY

i.      Report Methodology

ii.     Overview

iii.    Cardiovascular and Thoracic Surgery

iv.    Cosmetic and Plastic Surgery

v.     General Surgery

vi.    Gynecologic and Obstetric Surgery

vii.   Major Organ and Tissue Transplantation

viii.   Ophthalmic Surgery

ix.    Orthopedic and Spinal Surgery

x.     Urologic Surgery

xi.    Miscellaneous Surgery

Exhibit ES-1:  Surgical Procedure Volumes Forecast, by Setting, 2004-2012

Exhibit ES-2:  Share of Surgical Procedures, by Setting, 2004-2012

Exhibit ES-3:  Surgical Procedure Volumes Forecast, by Category, 2004-2012

Exhibit ES-4:  2005, Patients Awaiting Organ Transplants in the United States, by Type

1. CARDIOVASCULAR AND THORACIC PROCEDURES

1.1 Cardiovascular Disease Overview

1.1.1 Prevalence and Mortality

1.1.2 Etiology and Epidemiology of Cardiovascular Disorders

1.1.2.1 Arrhythmia Disorders

1.1.2.1.1 Arterial Fibrillation

1.1.2.1.2 Supraventricular Tachycardia

1.1.2.1.3 Ventricular Fibrillation

1.1.2.1.4 Ventricular Tachycardia

1.1.2.2 Circulatory Disorders

1.1.2.2.1 Acute Myocardial Infarction

1.1.2.2.2 Angina Pectoris

1.1.2.2.3 Aortic Aneurysm

1.1.2.2.4 Atherosclerosis

1.1.2.2.5 Hypercholesterolemia

1.1.2.2.6 Hypertension

1.1.2.2.7 Ischemic Heart Disease

1.1.2.2.8 Stroke

1.1.2.2.9 Venous Thromboembolism: Deep Vein Thrombosis and Pulmonary Embolism

1.1.2.3 Myocardial Diseases

1.1.2.3.1 Congenital Heart Defects

1.1.2.3.2 Congestive Heart Failure

1.1.2.3.3 Rheumatic Heart Disease

1.1.2.3.4 Valvular Disorders

1.2 Aneurysm Repair

1.3 Coronary Artery Disease Treatment

1.3.1 Atherectomy

1.3.2 Coronary Artery Bypass Graft Surgery

1.3.2.1 Less Invasive Coronary Artery Bypass Graft Techniques

1.3.2.2 Percutaneous Coronary Revascularization Techniques

1.3.3 Laser Angioplasty

1.3.4 Transmyocardial Revascularization

1.3.4.1 Percutaneous Transmyocardial Revascularization

1.3.5 Percutaneous Transluminal Coronary Angioplasty

1.3.5.1 Stenting

1.3.5.1.1 Drug-Eluting Coronary Stents

1.4 Peripheral Arterial Disease Treatment

1.4.1 Carotid Endarterectomy and Thromboendarterectomy

1.4.2 Femoropopliteal Bypass

1.4.3 Percutaneous Peripheral Revascularization Techniques

1.4.3.1 Peripheral Atherectomy

1.4.3.2 Peripheral Stenting

1.4.3.3 Percutaneous Transluminal Peripheral Angioplasty

1.4.3.4 Thrombolysis and Thrombectomy

1.5 Emerging Revascularization Technologies

1.5.1 Genetically Altered Tissue

1.5.2 Photoangioplasty

1.5.3 Synthetic Coronary Artery Bypass Grafts

1.5.4 Therapeutic Angiogenesis

1.6 Heart Defect Repair

1.6.1 Congenital Heart Defect Repair

1.6.2 Heart Valve Repair and Replacement

1.6.2.1 Percutaneous Balloon Valvuloplasty

1.6.2.2 Other Percutaneous Techniques

1.7 Cardiac Device Implantation

1.7.1 Pacemakers

1.8 Cardiac Resynchronization Therapy

1.8.1 Cardiac Resynchronization Systems

1.8.2 Automatic Implantable Cardioverter Defibrillators

1.8.3 Ventricular Assist Devices

1.9 Carotid Artery Occlusion and Stroke Prevention

1.9.1 Carotid Artery Stenting

1.9.2 Embolic Containment Systems

1.10 Thoracic Organ Transplantation

1.10.1 Heart Transplantation

1.10.2 Heart-Lung Transplantation

1.10.3 Lung Transplantation

1.11 Thoracic Surgery

1.11.1 Thoracoscopy

1.11.2 Thoracotomy

Exhibit 1-1:    2004, United States, Estimated Direct and Indirect Costs of Cardiovascular Disease and Stroke

Exhibit 1-2:    United States, Cardiovascular Disease Prevalence and Mortality Statistics

Exhibit 1-3:    Aneurysm Repair, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 1-4:    Coronary Atherectomy and Laser Angioplasty, Procedure Volumes Forecast, 2004-2012

Exhibit 1-5:    Coronary Artery Bypass Grafts, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 1-6:    On-Pump and Off-Pump Coronary Artery Bypass Grafts, Procedure Volumes Forecast, 2004-2012

Exhibit 1-7:    Percutaneous Transluminal Coronary Angioplasty, with and without Stenting, Procedure Volumes Forecast, 2004-2012

Exhibit 1-8:    Endarterectomy and Thromboendarterectomy, Procedure Volumes Forecast, 2004-2012

Exhibit 1-9:    Femoropopliteal Bypass, Procedure Volumes Forecast, 2004-2012

Exhibit 1-10:  Peripheral Atherectomy, Procedure Volumes Forecast, 2004-2012

Exhibit 1-11:  Peripheral Stenting, Procedure Volumes Forecast, 2004-2012

Exhibit 1-12:  Percutaneous Transluminal Peripheral Angioplasty, Procedure Volumes Forecast, 2004-2012

Exhibit 1-13:  Thrombolysis and Thrombectomy, Procedure Volumes Forecast, 2004-2012

Exhibit 1-14:  Congenital Heart Defect Repair, Procedure Volumes Forecast, 2004-2012

Exhibit 1-15:  Heart Valve Replacement and Repair, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 1-16:  Pacemaker Implantation and Replacement, Procedure Volumes Forecast, 2004-2012

Exhibit 1-17:  Cardiac Resynchronization Therapy System Implantation, Procedure Volumes Forecast, 2004-2012

Exhibit 1-18:  Automatic Implantable Cardioverter Defibrillator Implantation, Procedure Volumes Forecast, 2004-2012

Exhibit 1-19:  Ventricular Assist Devices, Bridge-to-Transplant Patients, Survival and Recovery Rates

Exhibit 1-20:  Ventricular Assist Device Implantation, Procedure Volumes Forecast, 2004-2012

Exhibit 1-21:  Thoracic Organ Transplantation, Historical Procedure Volumes, by Type, 1993-2003

Exhibit 1-22:  Thoracotomy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 1-23:  Thoracoscopy, Procedure Volumes Forecast, by Type, 2004-2012

2. COSMETIC SURGICAL PROCEDURES

2.1 Augmentation and Reduction Mammoplasty

2.2 Blepharoplasty

2.3 Hair Transplantation

2.4 Liposuction

2.5 Rhytidectomy

2.6 The Future of Plastic Surgery

Exhibit 2-1:    Augmentation and Reduction Mammoplasty, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 2-2:    Blepharoplasty, Procedure Volumes Forecast, 2004-2012

Exhibit 2-3:    Hair Transplantation, Procedure Volumes Forecast, 2004-2012

Exhibit 2-4:    Liposuction, Procedure Volumes Forecast, 2004-2012

Exhibit 2-5:    Rhytidectomy, Procedure Volumes Forecast, 2004-2012

3. GENERAL SURGICAL PROCEDURES

3.1 Abdominal Adhesiolysis

3.2 Appendectomy

3.3 Bariatric Surgery

3.3.1 Laparoscopic Bariatric Procedures

3.4 Cholecystectomy

3.5 Esophagogastric Fundoplasty

3.6 Inguinal Herniorrhaphy

3.7 Large Intestine Procedures

3.7.1 Colectomy and Sigmoidectomy

3.7.1.1 Laparoscopic Colectomy

3.7.2 Hemorrhoid Surgery

3.8 Liver Biopsy

Exhibit 3-1:    Open and Laparoscopic Abdominal Adhesiolysis, Procedure Volumes Forecast, 2004-2012

Exhibit 3-2:    Open and Laparoscopic Appendectomy, Procedure Volumes Forecast, 2004-2012

Exhibit 3-3:    Open and Laparoscopic Bariatric Gastric Bypass, Procedure Volumes Forecast, 2004-2012

Exhibit 3-4:    Open and Laparoscopic Cholecystectomy, Procedure Volumes Forecast, 2004-2012

Exhibit 3-5:    Open and Laparoscopic Esophagogastric Fundoplasty, Procedure Volumes Forecast, 2004-2012

Exhibit 3-6:    Open and Laparoscopic Inguinal Herniorrhaphy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 3-7:    Colectomy and Sigmoidectomy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 3-8:    Hemorrhoidectomy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 3-9:    Outpatient Hemorrhoidectomy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 3-10:  Open and Closed Liver Biopsy, Procedure Volumes Forecast, 2004-2012

4. GYNECOLOGIC AND OBSTETRIC PROCEDURES

4.1 Laparoscopic and Open Gynecologic Procedures

4.1.1 Dilation and Curettage

4.1.2 Hysterectomy

4.1.2.1 Minimally Invasive Hysterectomy

4.1.3 Hysteroscopy

4.1.3.1 Endometrial Ablation

4.1.3.2 Myomectomy

4.1.3.2.1 Minimally Invasive Myomectomy

4.1.4 Infertility Diagnostic Procedures

4.1.4.1 Hysterosonography, Hysterosalpingography, and Laparoscopy

4.2 Female Sterilization

4.2.1 Bilateral Tubal Ligation

4.3 Obstetric Procedures

4.3.1 Cesarean Section

Exhibit 4-1:    Dilation and Curettage, Procedure Volumes Forecast, by Facility Type, 2004-2012

Exhibit 4-2:    Hysterectomy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 4-3:    Hysteroscopy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 4-4:    Open Myomectomy, Procedure Volumes Forecast, 2004-2012

Exhibit 4-5:    Tubal Patency Screening, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 4-6:    Tubal Ligation, Procedure Volumes Forecast, 2004-2012

Exhibit 4-7:    Live Births, Historical Procedure Volumes, 1990-2002

Exhibit 4-8:    Live Births, Procedure Volumes Forecast, 2004-2012

Exhibit 4-9:    Cesarean Section Delivery, Procedure Volumes Forecast, 2004-2012

5. MAJOR ORGAN AND TISSUE TRANSPLANTATION

5.1 Donor Shortage

5.2 Overview of Organ Transplantation

5.2.1 Immunosuppressive Strategies

5.2.2 New Transplantation Data

5.3 Bone Marrow Transplantation

5.3.1 Syngeneic Transplants

5.3.2 Allogenic Transplants

5.3.3 Autologous Transplants

5.3.4 Alternative Sources of Stem Cells

5.4 Cornea Transplantation

5.5 Heart Transplantation

5.5.1 Heart-Lung Transplantation

5.6 Intestine Transplantation

5.7 Kidney Transplantation

5.8 Liver Transplantation

5.9 Lung Transplantation

5.10 Pancreas Transplantation

5.10.1 Kidney-Pancreas Transplantation

Exhibit 5-1:    Longest-Living Adult Transplant Patient Survival in the United States

Exhibit 5-2:    2005, Patients Awaiting Organ Transplants in the United States, by Type

Exhibit 5-3:    2005, Organ Transplant Programs in the United States, by Type

Exhibit 5-4:    2004, Major Organ Transplantation Procedures Performed in the United States, by Type

Exhibit 5-5:    Cadaveric and Living Organ Transplants, by Type, 1993-2003

Exhibit 5-6:    Major Organ Transplantation, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 5-7:    Diseases Treated by Bone Marrow Transplantation

Exhibit 5-8:    Cornea Transplantation, Procedure Volumes Forecast, 2004-2012

Exhibit 5-9:    Heart Transplantation, Patient Survival Rates, 1996-2001

Exhibit 5-10:  Heart-Lung Transplantation, Patient Survival Rates, 1996-2001

Exhibit 5-11:  Intestine Transplantation, Patient Survival Rates, 1996-2001

Exhibit 5-12:  Living Donor Kidney Transplantation, Patient Survival Rates, 1996-2001

Exhibit 5-13:  Cadaveric Donor Kidney Transplantation, Patient Survival Rates, 1996-2001

Exhibit 5-14:  Living Liver Transplantation, Patient Survival Rates, 1996-2001

Exhibit 5-15:  Cadaveric Liver Transplantation, Patient Survival Rates, 1996-2001

Exhibit 5-16:  Living Donor Lung Transplantation, Patient Survival Rates, 1996-2001

Exhibit 5-17:  Cadaveric Donor Lung Transplantation, Patient Survival Rates, 1996-2001

Exhibit 5-18:  Pancreas and Kidney-Pancreas Transplantation, Patient Survival Rates, 1996-2001

6. OPHTHALMIC PROCEDURES

6.1 Age-Related Macular Degeneration

6.1.1 Photodynamic Therapy

6.1.2 Transpupillary Thermotherapy

6.2 Cataract Surgery

6.2.1 Laser-Based Cataract Surgery

6.2.2 Ultrasonic Phacoemulsification

6.3 Diabetic Retinopathy

6.4 Glaucoma

6.5 Refractive Surgery

6.5.1 Radial Keratotomy

6.5.2 Photorefractive Keratotomy

6.5.3 Laser-Assisted In Situ Keratomileusis

6.6 Strabismus Correction

6.7 Vitrectomy

Exhibit 6-1:    Macular Degeneration Laser Surgery, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 6-2:    Cataract Surgery, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 6-3:    Diabetic Retinopathy Laser Surgery, Procedure Volumes Forecast, 2004-2012

Exhibit 6-4:    Glaucoma Surgery, Procedure Volumes Forecast, 2004-2012

Exhibit 6-5:    Refractive Surgery, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 6-6:    Strabismus Correction, Procedure Volumes Forecast, 2004-2012

Exhibit 6-7:    Vitrectomy, Procedure Volumes Forecast, 2004-2012

7. ORTHOPEDIC AND SPINAL PROCEDURES

7.1 Fracture Repair

7.1.1 Bone Grafts

7.1.2 Biotechnology in Fracture Repair

7.2 Total Joint Replacement

7.2.1 Knee Replacement

7.2.1.1 Revision Knee Replacement

7.2.1.2 Unicompartmental Knee Replacement

7.2.2 Hip Replacement

7.2.2.1 Revision Hip Replacement

7.3 Spinal Surgery

7.3.1 Nerve Root Compression

7.3.1.1 Discectomy

7.3.1.2 Laminectomy and Laminotomy

7.3.2 Spinal Fusion

7.3.2.1 Anterior Lumbar Interbody Fusion

7.3.2.2 Posterior Lumbar Interbody Fusion

7.3.2.3 Instrumented Fusion

7.3.3 Vertebroplasty

7.4 Arthroscopy

7.4.1 Ankle Arthroscopy

7.4.2 Knee Arthroscopy

7.4.2.1 Cartilage Repair

7.4.2.2 Meniscal Repair and Replacement

7.4.2.3 Meniscal Allograft Transplantation

7.4.2.4 Anterior Cruciate Ligament Reconstruction

7.4.2.5 Posterior Cruciate Ligament Treatment

7.4.3 Hip Arthroscopy

7.4.4 Shoulder Arthroscopy

7.4.4.1 Recurrent Anterior Shoulder Dislocation Treatment

7.4.4.2 Acromioclavicular Joint Resection

7.4.4.3 Rotator Cuff Repair

7.4.5 Wrist Arthroscopy

7.4.5.1 Carpal Tunnel Release

Exhibit 7-1:    Open Reduction with Internal Fixation of the Femur or Tibia/Fibula, Procedure Volumes Forecast, 2004-2012

Exhibit 7-2:    Primary and Revision Knee Replacement, Procedure Volumes Forecast, 2004-2012

Exhibit 7-3:    Unicompartmental Knee Replacement, Procedure Volumes Forecast, 2004-2012

Exhibit 7-4:    Primary Total and Partial Hip Replacement, Procedure Volumes Forecast, 2004-2012

Exhibit 7-5:    Primary Total Hip Replacement, Procedure Volumes Forecast, by Age Group, 2004-2012

Exhibit 7-6:    Revision Total Hip Replacement, Procedure Volumes Forecast, 2004-2012

Exhibit 7-7:    Discectomy, Procedure Volumes Forecast, 2004-2012

Exhibit 7-8:    Laminectomy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 7-9:    Laminotomy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 7-10:  Spinal Fusion and Refusion, Procedure Volumes Forecast, 2004-2012

Exhibit 7-11:  Spinal Fusion, Procedure Volumes Forecast, by Anatomic Site, 2004-2012

Exhibit 7-12:  Arthroscopic Knee Surgery, Excluding Ligament and Meniscal Repair, Procedure Volumes Forecast, 2004-2012

Exhibit 7-13:  Meniscectomy and Meniscal Repair, Procedure Volumes Forecast, 2004-2012

Exhibit 7-14:  Arthroscopic and Open Anterior Cruciate Ligament Reconstruction, Procedure Volumes Forecast, 2004-2012

Exhibit 7-15:  Arthroscopic Shoulder Surgery, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 7-16:  Carpal Tunnel Release, Procedure Volumes Forecast, by Type, 2004-2012

8. UROLOGIC PROCEDURES

8.1 Incontinence Management

8.2 Nephrectomy

8.3 Prostatic Procedures

8.3.1 Prostatectomy

8.3.2 Transurethral Resection of the Prostate

8.3.3 Minimally Invasive Benign Prostatic Hyperplasia Therapy

8.4 Stone and Obstruction Removal

Exhibit 8-1:    Stress Urinary Incontinence Suspensions and Slings, Procedure Volumes Forecast, 2004-2012

Exhibit 8-2:    Nephrectomy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 8-3:    Radical Prostatectomy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 8-4:    Benign Prostatic Hyperplasia Therapy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 8-5:    Minimally Invasive Benign Prostatic Hyperplasia Therapy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 8-6:    Kidney Stone Removal, Procedure Volumes Forecast, by Type, 2004-2012

9. MISCELLANEOUS SURGICAL PROCEDURES

9.1 Breast Procedures

9.1.1 Biopsy

9.1.1.1 Surgical Biopsy

9.1.1.2 Minimally Invasive Percutaneous Biopsy

9.1.1.3 Vacuum-Assisted Biopsy

9.1.1.4 Wide Excision Biopsy or Lumpectomy

9.1.1.5 Other Biopsy Methods

9.1.2 Mastectomy

9.1.2.1 Prophylactic Mastectomy

9.1.2.2 Simple Mastectomy

9.1.2.3 Radical and Modified Radical Mastectomy

9.1.2.4 Partial Mastectomy

9.2 Ear, Nose, and Throat Procedures

9.2.1 Sinus Procedures

9.2.2 Tonsillectomy/Adenoidectomy

9.2.2.1 New Surgical Approaches

9.2.3 Tracheotomy

9.3 Splenectomy

Exhibit 9-1:    Lumpectomy, Procedure Volumes Forecast, by Inpatient and Outpatient Setting, 2004-2012

Exhibit 9-2:    Breast Biopsy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 9-3:    Mastectomy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 9-4:    Diagnostic Endoscopic and Inpatient Sinus Surgery, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 9-5:    Tonsillectomy and Adenoidectomy, Procedure Volumes Forecast, by Type, 2004-2012

Exhibit 9-6:    Planned and Emergency Tracheotomy, Procedure Volumes Forecast, 2004-2012

Exhibit 9-7:    Splenectomy, Procedure Volumes Forecast, 2004-2012

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