$4,750.00
This report presents the most common surgical procedures performed in the United States (U.S.) as well as an overview of the etiology and epidemiology of selected diseases/disorders, prevailing surgical approaches/techniques, and evolving procedural utilization trends.
This report presents the most common surgical procedures performed in the United States (U.S.) as well as an overview of the etiology and epidemiology of selected diseases/disorders, prevailing surgical approaches/techniques, and evolving procedural utilization trends. The forecast period covered by this report is for the years 2011 through 2018, with compound annual growth rates for the years 2012 through 2018. Surgical procedures covered by this report include:
• cardiovascular/peripheral vascular/thoracic;
• cosmetic;
• general;
• major organ/stem cell/tissue transplantation;
• neurosurgical;
• obstetric/gynecologic;
• ophthalmic;
• orthopedic/spine;
• urologic; and,
• miscellaneous.
Over the years, the number of outpatient surgical procedures performed in the U.S. has been gradually expanding, reflecting the steady migration of patients from acute care settings. By the end of 2010, outpatient procedures accounted for more than 50% of all surgeries and transcatheter interventions performed in the U.S.; this compares to an estimated 30% in 2000. The trend toward outpatient procedures is expected to continue over the forecast period covered by this report, though at a somewhat slower pace than in previous years.
1. CARDIOVASCULAR/THORACIC SURGICAL PROCEDURES …………….. 1-1
1.1 Circulatory Vascular Disorders …………………………………………………. 1-1
1.1.1 Atherosclerosis………………………………………………………… 1-2
1.1.2 Coronary Heart Disease……………………………………………. 1-3
1.1.3 Angina Pectoris ……………………………………………………….. 1-4
1.1.4 Acute Myocardial Infarction ……………………………………….. 1-5
1.1.5 Peripheral Vascular Disease ……………………………………… 1-7
1.1.5.1 Aortic Aneurysm………………………………………… 1-7
1.1.5.2 Lower Extremity Arterial Occlusion……………….. 1-8
1.1.5.3 Deep Vein Thrombosis and
Pulmonary Embolism ……………………………….. 1-10
1.2 Myocardial Disorders…………………………………………………………….. 1-12
1.2.1 Congenital Heart Defects ………………………………………… 1-12
1.2.2 Heart Valve Disorders …………………………………………….. 1-14
1.2.3 Heart Failure………………………………………………………….. 1-17
1.3 Cardiac Rhythm Disorders …………………………………………………….. 1-21
1.3.1 Bradycardia …………………………………………………………… 1-21
1.3.2 Supraventricular Tachycardia…………………………………… 1-22
1.3.2.1 Atrial Fibrillation……………………………………….. 1-22
1.3.3 Ventricular Tachycardia…………………………………………… 1-24
1.3.3.1 Ventricular Fibrillation……………………………….. 1-25
1.4 Therapeutic Management of Circulatory Disorders ……………………. 1-26
1.4.1 Coronary Artery Disease Treatment………………………….. 1-26
1.4.1.1 Coronary Artery Bypass Graft Surgery………… 1-27
1.4.1.1.1 Less Invasive Coronary Artery
Bypass Graft Surgery…………….. 1-27
1.4.1.1.2 Patient Indications…………………. 1-29
1.4.1.1.3 Procedure Volumes ………………. 1-31
1.4.1.2 Percutaneous Coronary Interventions …………. 1-32
1.4.1.2.1 Percutaneous Transluminal
Coronary Angioplasty
and Stenting…………………………. 1-32
1.4.1.2.1.1 Procedure
Volumes …………… 1-36
1.4.1.2.2 Mechanical Atherectomy………… 1-37
1.4.1.2.2.1 Procedure
Volumes …………… 1-40
1.4.1.2.3 Laser Coronary Atherectomy ….. 1-41
1.4.1.2.3.1 Procedure
Volumes …………… 1-43
1.4.1.2.4 Mechanical Coronary
Thrombectomy……………………… 1-44
1.4.1.2.4.1 Procedure
Volumes …………… 1-44
1.4.1.3 Transmyocardial Laser Revascularization……. 1-46
1.4.1.3.1 Procedure Volumes ………………. 1-48
1.4.2 Peripheral Vascular Disease Treatment…………………….. 1-49
1.4.2.1 Aortic Aneurysm Treatment Regimens………… 1-49
1.4.2.1.1 Surgical Repair of
Aortic Aneurysms………………….. 1-49
1.4.2.1.2 Abdominal Aortic Aneurysm
Repair/Endovascular
Stent Grafting……………………….. 1-51
1.4.2.1.2.1 Limitations of
Endovascular
Abdominal Aortic
Aneurysm Repair.. 1-52
1.4.2.1.3 Endovascular Thoracic Aortic
Aneurysm Repair ………………….. 1-52
1.4.2.1.4 Procedure Volumes ………………. 1-53
1.4.2.2 Treatment of Lower Extremity
Arterial Occlusions …………………………………… 1-54
1.4.2.2.1 Bypass Graft Surgery for Lower
Extremity Revascularization……. 1-54
1.4.2.2.1.1 Aortoiliofemoral
Bypass Graft
Surgery…………….. 1-56
1.4.2.2.1.2 Tibioperoneal
Reconstruction ….. 1-56
1.4.2.2.1.3 Femoropopliteal
Bypass Surgery …. 1-57
1.4.2.2.1.4 Procedure
Volumes …………… 1-57
1.4.2.2.2 Percutaneous Transluminal
Angioplasty ………………………….. 1-58
1.4.2.2.2.1 Procedure
Volumes …………… 1-60
1.4.2.2.3 Lower Extremity Stenting ……….. 1-60
1.4.2.2.3.1 Iliac Artery
Stenting ……………. 1-62
1.4.2.2.3.2 Femoropopliteal
Artery Stenting…… 1-63
1.4.2.2.3.3 Infrapopliteal/
Below-the-Knee
Stenting ……………. 1-63
1.4.2.2.3.4 Procedure
Volumes …………… 1-64
1.4.2.2.4 Peripheral Mechanical
Atherectomy…………………………. 1-64
1.4.2.2.4.1 Procedure
Volumes …………… 1-66
1.4.2.2.5 Peripheral Excimer
Laser Atherectomy………………… 1-68
1.4.2.2.5.1 Procedure
Volumes …………… 1-68
1.4.2.2.6 Peripheral Mechanical
Thrombectomy……………………… 1-69
1.4.2.2.6.1 Procedure
Volumes …………… 1-71
1.5 Therapeutic Management of Myocardial Disorders ……………………. 1-71
1.5.1 Congenital Heart Defect Repair………………………………… 1-71
1.5.1.1 Procedure Volumes………………………………….. 1-73
1.5.2 Treatment of Heart Valve Disorders ………………………….. 1-76
1.5.2.1 Percutaneous Balloon Valvuloplasty …………… 1-76
1.5.2.1.1 Procedure Volumes ………………. 1-77
1.5.2.2 Heart Valve Repair and Replacement…………. 1-78
1.5.2.2.1 Procedure Volumes ………………. 1-80
1.5.3 Ventricular Assist Devices for Late-Stage Heart Failure.. 1-81
1.5.3.1 Procedure Volumes………………………………….. 1-86
1.6 Implantable Devices for Cardiac Rhythm Management………………. 1-86
1.6.1 Cardiac Pacing Systems …………………………………………. 1-88
1.6.1.1 Magnetic Resonance
Imaging-Safe Pacemakers ………………………… 1-89
1.6.1.2 Procedure Volumes………………………………….. 1-89
1.6.2 Implantable Cardioverter Defibrillators ………………………. 1-90
1.6.2.1 Procedure Volumes………………………………….. 1-93
1.6.3 Cardiac Resynchronization Therapy Systems…………….. 1-93
1.6.3.1 Procedure Volumes………………………………….. 1-96
1.7 Thoracic Surgery ………………………………………………………………….. 1-97
1.7.1 Thoracotomy …………………………………………………………. 1-99
1.7.2 Thoracoscopy………………………………………………………. 1-100
Exhibit 1-1: On-Pump and Off-Pump Coronary Artery Bypass Graft Surgery,
Procedure Volumes Forecast, 2011-2018………………………………… 1-33
Exhibit 1-2: Percutaneous Transluminal Coronary Angioplasty/Stenting,
Procedure Volumes Forecast, 2011-2018………………………………… 1-38
Exhibit 1-3: Mechanical Coronary Atherectomy,
Procedure Volumes Forecast, 2011-2018………………………………… 1-42
Exhibit 1-4: Laser Coronary Atherectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 1-45
Exhibit 1-5: Mechanical Coronary Thrombectomy,
Procedure Volumes Forecast, 2011-2018………………………………… 1-47
Exhibit 1-6: Transmyocardial Laser Revascularization,
Procedure Volumes Forecast, 2011-2018………………………………… 1-50
Exhibit 1-7: Aortic Aneurysm Repair, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 1-55
Exhibit 1-8: Lower Extremity Surgical Bypass Grafting,
Procedure Volumes Forecast, 2011-2018………………………………… 1-59
Exhibit 1-9: Percutaneous Transluminal Angioplasty,
Procedure Volumes Forecast, 2011-2018………………………………… 1-61
Exhibit 1-10: Lower Extremity Stenting, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 1-65
Exhibit 1-11: Peripheral Mechanical Atherectomy,
Procedure Volumes Forecast, 2011-2018………………………………… 1-67
Exhibit 1-12: Peripheral Excimer Laser Atherectomy,
Procedure Volumes Forecast, 2011-2018………………………………… 1-70
Exhibit 1-13: Peripheral Mechanical Thrombectomy,
Procedure Volumes Forecast, 2011-2018………………………………… 1-72
Exhibit 1-14: Clinical Presentation and Share of Common
Congenital Heart Defects ………………………………………………………. 1-74
Exhibit 1-15: Congenital Heart Defect Repair,
Procedure Volumes Forecast, 2011-2018………………………………… 1-75
Exhibit 1-16: Percutaneous Balloon Valvuloplasty,
Procedure Volumes Forecast, 2011-2018………………………………… 1-79
Exhibit 1-17: Heart Valve Repair and Replacement,
Procedure Volumes Forecast, 2011-2018………………………………… 1-82
Exhibit 1-18: Ventricular Assist Device Placement,
Procedure Volumes Forecast, 2011-2018………………………………… 1-87
Exhibit 1-19: Pacemaker Implantation, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 1-91
Exhibit 1-20: Implantable Cardioverter Defibrillator Placement,
Procedure Volumes Forecast, 2011-2018………………………………… 1-94
Exhibit 1-21: Cardiac Resynchronization Therapy Device Placement,
Procedure Volumes Forecast, 2011-2018………………………………… 1-98
Exhibit 1-22: Thoracotomy, Procedure Volumes Forecast, 2011-2018 ………….. 1-101
Exhibit 1-23: Thoracoscopy, Procedure Volumes Forecast, 2011-2018…………. 1-103
2. COSMETIC SURGICAL PROCEDURES ……………………………………………. 2-1
2.1 Abdominoplasty……………………………………………………………………… 2-2
2.2 Augmentation and Reduction Mammoplasty………………………………. 2-3
2.3 Blepharoplasty……………………………………………………………………….. 2-7
2.4 Hair Transplantation ……………………………………………………………… 2-11
2.5 Liposuction ………………………………………………………………………….. 2-14
2.6 Rhytidectomy……………………………………………………………………….. 2-16
2.7 Trends in Cosmetic Surgery …………………………………………………… 2-18
Exhibit 2-1: Abdominoplasty, Procedure Volumes Forecast, 2011-2018………….. 2-4
Exhibit 2-2: Breast Augmentation and Reduction Mammoplasty,
Procedure Volumes Forecast, 2011-2018………………………………….. 2-8
Exhibit 2-3: Blepharoplasty, Procedure Volumes Forecast, 2011-2018 …………. 2-10
Exhibit 2-4: Hair Transplantation, Procedure Volumes Forecast, 2011-2018….. 2-13
Exhibit 2-5: Liposuction, Procedure Volumes Forecast, 2011-2018………………. 2-17
Exhibit 2-6: Rhytidectomy, Procedure Volumes Forecast, 2011-2018 …………… 2-19
3. GENERAL SURGICAL PROCEDURES……………………………………………… 3-1
3.1 Abdominal Adhesiolysis…………………………………………………………… 3-1
3.2 Appendectomy ………………………………………………………………………. 3-4
3.3 Bariatric Surgery…………………………………………………………………….. 3-6
3.4 Cholecystectomy ………………………………………………………………….. 3-11
3.5 Esophagogastric Fundoplasty ………………………………………………… 3-14
3.6 Inguinal Herniorrhaphy ………………………………………………………….. 3-17
3.7 Large Intestine Procedures ……………………………………………………. 3-20
3.7.1 Colectomy and Sigmoidectomy………………………………… 3-20
3.7.2 Hemorrhoid Surgery ……………………………………………….. 3-23
3.8 Liver Biopsy…………………………………………………………………………. 3-26
Exhibit 3-1: Abdominal Adhesiolysis, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………….. 3-5
Exhibit 3-2: Appendectomy, Procedure Volumes Forecast, 2011-2018 …………… 3-7
Exhibit 3-3: Bariatric/Gastric Bypass, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 3-12
Exhibit 3-4: Cholecystectomy, Procedure Volumes Forecast, 2011-2018………. 3-15
Exhibit 3-5: Esophagogastric Fundoplasty, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 3-18
Exhibit 3-6: Inguinal Herniorrhaphy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 3-21
Exhibit 3-7: Colectomy and Sigmoidectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 3-24
Exhibit 3-8: Hemorrhoidectomy, Procedure Volumes Forecast, 2011-2018……. 3-27
Exhibit 3-9: Liver Biopsy, Procedure Volumes Forecast, 2011-2018……………… 3-30
4. MAJOR ORGAN/STEM CELL/TISSUE TRANSPLANTATION ……………… 4-1
4.1 Organ Donor Shortage ……………………………………………………………. 4-1
4.2 Organ Transplants and Immunosuppressive Strategies……………….. 4-7
4.3 Major Organ Transplantation……………………………………………………. 4-9
4.3.1 Heart Transplants…………………………………………………….. 4-9
4.3.2 Heart-Lung Transplants…………………………………………….. 4-9
4.3.3 Intestinal Transplants ……………………………………………… 4-10
4.3.4 Kidney Transplants…………………………………………………. 4-11
4.3.5 Kidney-Pancreas Transplants ………………………………….. 4-12
4.3.6 Liver Transplants……………………………………………………. 4-12
4.3.7 Lung Transplants……………………………………………………. 4-13
4.3.8 Pancreas Transplants …………………………………………….. 4-14
4.3.9 Procedure Volumes………………………………………………… 4-15
4.4 Bone Marrow and Stem Cell Transplantation ……………………………. 4-19
4.4.1 Non-Myeloablative Transplants………………………………… 4-21
4.4.2 Syngeneic Transplants……………………………………………. 4-22
4.4.3 Allogeneic Transplants ……………………………………………. 4-22
4.4.4 Autologous Transplants…………………………………………… 4-22
4.4.5 Other Sources of Stem Cells……………………………………. 4-22
4.4.6 Procedure Volumes………………………………………………… 4-23
4.5 Corneal Transplantation ………………………………………………………… 4-26
4.5.1 Procedure Volumes………………………………………………… 4-30
Exhibit 4-1: 2013, Patients Awaiting Organ Transplants ……………………………….. 4-3
Exhibit 4-2: 2012, Major Organ Transplants………………………………………………… 4-6
Exhibit 4-3: 2012, Patient Survival Rates at 1 and 5 Years,
by Transplanted Organ………………………………………………………….. 4-16
Exhibit 4-4: Cadaveric and Living Donor Organ Transplants,
Historical Procedure Volumes, 2002-2012 ……………………………….. 4-17
Exhibit 4-5: Major Organ Transplantation, Procedure Volumes Forecast,
by Type, 2011-2018………………………………………………………………. 4-20
Exhibit 4-6: 2012, Unrelated Bone Marrow Stem Cell Transplants,
by Primary Diagnosis…………………………………………………………….. 4-24
Exhibit 4-7: Unrelated Bone Marrow Stem Cell Transplants,
Historical Procedure Volumes, by Primary Diagnosis
for Selected Years, 2002-2012……………………………………………….. 4-25
Exhibit 4-8: Unrelated Stem Cell Transplants, Historical Procedure Volumes,
by Cell Source, 2002-2012…………………………………………………….. 4-27
Exhibit 4-9: Unrelated Stem Cell Transplantation,
Procedure Volumes Forecast, by Cell Source, 2011-2018………….. 4-28
Exhibit 4-10: Corneal Transplantation, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 4-31
5. NEUROSURGICAL PROCEDURES ………………………………………………….. 5-1
5.1 Stroke…………………………………………………………………………………… 5-1
5.1.1 Hemorrhagic Stroke …………………………………………………. 5-1
5.1.2 Ischemic Stroke……………………………………………………….. 5-3
5.2 Cerebral Aneurysm…………………………………………………………………. 5-5
5.3 Arteriovenous Malformations……………………………………………………. 5-6
5.4 Tumors of the Brain and Central Nervous System ………………………. 5-7
5.5 Traumatic Brain Injury …………………………………………………………….. 5-9
5.6 Hydrocephalus and Increased Intracranial Pressure………………….. 5-10
5.7 Neurosurgical Procedures ……………………………………………………… 5-12
5.7.1 Cerebrospinal Fluid Shunting and Drainage……………….. 5-12
5.7.1.1 Procedure Volumes………………………………….. 5-14
5.7.2 Carotid Endarterectomy…………………………………………… 5-14
5.7.2.1 Procedure Volumes………………………………….. 5-16
5.7.3 Cerebral Aneurysm and Arteriovenous
Malformation Surgical Clipping…………………………………. 5-16
5.7.3.1 Procedure Volumes………………………………….. 5-19
5.7.4 Cerebral Aneurysm and Arteriovenous
Malformation Embolization ………………………………………. 5-19
5.7.4.1 Procedure Volumes………………………………….. 5-21
5.7.5 Carotid Artery Stenting ……………………………………………. 5-23
5.7.5.1 Carotid Revascularization Endarterectomy
versus Stenting Trial Results……………………… 5-24
5.7.5.2 Procedure Volumes………………………………….. 5-25
5.7.6 Intracranial Stenting ……………………………………………….. 5-26
5.7.6.1 Procedure Volumes………………………………….. 5-28
Exhibit 5-1: Cerebrospinal Fluid Shunting, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 5-15
Exhibit 5-2: Carotid Endarterectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 5-17
Exhibit 5-3: Cerebral Aneurysm and Arteriovenous Malformation
Surgical Clipping, Procedure Volumes Forecast, 2011-2018 ………. 5-20
Exhibit 5-4: Cerebral Aneurysm and Arteriovenous Malformation
Embolization, Procedure Volumes Forecast, 2011-2018…………….. 5-22
Exhibit 5-5: Distally Protected Carotid Artery Stenting,
Procedure Volumes Forecast, 2011-2018………………………………… 5-27
Exhibit 5-6: Intracranial Stenting, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 5-29
6. OBSTETRIC/GYNECOLOGIC SURGICAL PROCEDURES………………….. 6-1
6.1 Dysfunctional Uterine Bleeding ………………………………………………… 6-1
6.2 Gynecologic Procedures …………………………………………………………. 6-2
6.2.1 Dilation and Curettage………………………………………………. 6-3
6.2.1.1 Procedure Volumes……………………………………. 6-4
6.2.2 Hysterectomy ………………………………………………………….. 6-4
6.2.2.1 Minimally Invasive Techniques…………………….. 6-7
6.2.2.2 Procedure Volumes……………………………………. 6-8
6.2.3 Hysteroscopy…………………………………………………………… 6-8
6.2.3.1 Endometrial Ablation ………………………………… 6-11
6.2.3.2 Procedure Volumes………………………………….. 6-12
6.2.4 Myomectomy…………………………………………………………. 6-13
6.2.4.1 Procedure Volumes………………………………….. 6-16
6.2.5 Diagnostic Procedures for Infertility…………………………… 6-16
6.2.5.1 Hysterosonography, Hysterosalpingography,
and Laparoscopy……………………………………… 6-18
6.2.5.2 Procedure Volumes………………………………….. 6-20
6.3 Female Sterilization………………………………………………………………. 6-22
6.3.1 Tubal Ligation………………………………………………………… 6-22
6.3.1.1 Procedure Volumes………………………………….. 6-23
6.4 Obstetric Procedures…………………………………………………………….. 6-23
6.4.1 Live Birth ………………………………………………………………. 6-23
6.4.1.1 Procedure Volumes………………………………….. 6-25
6.4.2 Cesarean Section…………………………………………………… 6-25
6.4.2.1 Procedure Volumes………………………………….. 6-29
Exhibit 6-1: Dilation and Curettage, Procedure Volumes Forecast, 2011-2018 … 6-5
Exhibit 6-2: Hysterectomy, Procedure Volumes Forecast, 2011-2018 …………….. 6-9
Exhibit 6-3: Hysteroscopy, Procedure Volumes Forecast, 2011-2018 …………… 6-14
Exhibit 6-4: Myomectomy, Procedure Volumes Forecast, 2011-2018……………. 6-17
Exhibit 6-5: Diagnostic Examinations for Infertility,
Procedure Volumes Forecast, 2011-2018………………………………… 6-21
Exhibit 6-6: Tubal Ligation, Procedure Volumes Forecast, 2011-2018…………… 6-24
Exhibit 6-7: Live Births, Historical Procedure Volumes, 1991-2011……………….. 6-26
Exhibit 6-8: Live Births, Procedure Volumes Forecast, 2011-2018 ……………….. 6-27
Exhibit 6-9: Cesarean Section, Procedure Volumes Forecast, 2011-2018……… 6-30
7. Ophthalmic Surgical Procedures…………………………………………………….. 7-1
7.1 Age-Related Macular Degeneration ………………………………………….. 7-1
7.1.1 Anti-Angiogenic Therapy …………………………………………… 7-2
7.1.2 Verteporfin Photodynamic Therapy …………………………….. 7-2
7.1.3 Transpupillary Thermotherapy……………………………………. 7-3
7.1.4 Retinal Photocoagulation…………………………………………… 7-4
7.1.5 Procedure Volumes………………………………………………….. 7-4
7.2 Cataract Surgery ……………………………………………………………………. 7-6
7.2.1 Capsulotomy …………………………………………………………. 7-10
7.2.2 Procedure Volumes………………………………………………… 7-10
7.3 Diabetic Retinopathy …………………………………………………………….. 7-10
7.3.1 Procedure Volumes………………………………………………… 7-14
7.4 Glaucoma Surgery………………………………………………………………… 7-14
7.4.1 Procedure Volumes………………………………………………… 7-18
7.5 Refractive Surgery………………………………………………………………… 7-18
7.5.1 Laser-Based Vision Correction…………………………………. 7-20
7.5.1.1 Photorefractive Keratectomy ……………………… 7-20
7.5.1.2 Laser In Situ Keratomileusis………………………. 7-21
7.5.1.2.1 Laser Epithelial Keratomileusis.. 7-22
7.5.1.2.2 Custom Laser
In Situ Keratomileusis ……………. 7-22
7.5.1.2.3 Photoablative Inlay Laser
In Situ Keratomileusis ……………. 7-23
7.5.1.3 Procedure Volumes………………………………….. 7-23
7.6 Strabismus Correction…………………………………………………………… 7-24
7.6.1 Procedure Volumes………………………………………………… 7-26
7.7 Vitrectomy …………………………………………………………………………… 7-28
7.7.1 Procedure Volumes………………………………………………… 7-29
Exhibit 7-1: Laser Therapy for Age-Related Macular Degeneration,
Procedure Volumes Forecast, 2011-2018………………………………….. 7-5
Exhibit 7-2: Cataract Surgery, Procedure Volumes Forecast, 2011-2018 ………. 7-11
Exhibit 7-3: Diabetic Retinopathy Laser Surgery,
Procedure Volumes Forecast, 2011-2018 …………………………………… 15
Exhibit 7-4: Glaucoma Surgery, Procedure Volumes Forecast, 2011-2018 ……. 7-19
Exhibit 7-5: Refractive Laser Surgery, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 7-25
Exhibit 7-6: Strabismus Correction, Procedure Volumes Forecast, 2011-2018.. 7-27
Exhibit 7-7: Vitrectomy, Procedure Volumes Forecast, 2011-2018 ……………….. 7-30
8. ORTHOPEDIC/SPINE SURGICAL PROCEDURES……………………………… 8-1
8.1 Bone Fracture Repair ……………………………………………………………… 8-2
8.1.1 Bone Grafting ………………………………………………………….. 8-4
8.1.2 Biotechnology in Bone Fracture Repair……………………….. 8-6
8.1.3 Procedure Volumes………………………………………………….. 8-7
8.2 Total Joint Arthroplasty……………………………………………………………. 8-9
8.2.1 Total Knee Arthroplasty…………………………………………… 8-10
8.2.1.1 Procedure Volumes………………………………….. 8-11
8.2.2 Unicompartmental Knee Arthroplasty………………………… 8-11
8.2.2.1 Procedure Volumes………………………………….. 8-13
8.2.3 Hip Arthroplasty……………………………………………………… 8-15
8.2.3.1 Revision Hip Arthroplasty ………………………….. 8-18
8.2.3.2 Procedure Volumes………………………………….. 8-18
8.3 Spine Surgery………………………………………………………………………. 8-20
8.3.1 Total Disc Replacement ………………………………………….. 8-21
8.3.2 Nerve Root Decompression …………………………………….. 8-22
8.3.2.1 Discectomy……………………………………………… 8-22
8.3.2.1.1 Procedure Volumes ………………. 8-23
8.3.2.2 Laminectomy and Laminotomy…………………… 8-23
8.3.2.2.1 Procedure Volumes ………………. 8-26
8.3.3 Spinal Fusion…………………………………………………………. 8-26
8.3.3.1 Anterior Lumbar Interbody Fusion………………. 8-28
8.3.3.2 Posterior Lumbar Interbody Fusion …………….. 8-29
8.3.3.3 Lateral Lumbar Interbody Fusion………………… 8-29
8.3.3.4 Instrumented Fusion…………………………………. 8-29
8.3.4 Vertebroplasty ……………………………………………………….. 8-30
8.3.4.1 Procedure Volumes………………………………….. 8-31
8.4 Arthroscopy …………………………………………………………………………. 8-31
8.4.1 Knee Arthroscopy…………………………………………………… 8-31
8.4.1.1 Procedure Volumes………………………………….. 8-33
8.4.1.2 Cartilage Repair and Transplantation………….. 8-34
8.4.1.3 Meniscectomy …………………………………………. 8-36
8.4.1.3.1 Procedure Volumes ………………. 8-37
8.4.1.4 Anterior Cruciate Ligament Reconstruction….. 8-37
8.4.1.4.1 Procedure Volumes ………………. 8-40
8.4.2 Shoulder Arthroscopy……………………………………………… 8-40
8.4.2.1 Primary Anterior Shoulder Dislocation…………. 8-42
8.4.2.2 Recurrent Anterior Shoulder Dislocation ……… 8-42
8.4.2.3 Acromioclavicular Joint Resection………………. 8-43
8.4.2.4 Rotator Cuff Repair ………………………………….. 8-44
8.4.2.5 Procedure Volumes………………………………….. 8-45
8.4.3 Wrist Arthroscopy …………………………………………………… 8-46
8.4.3.1 Carpal Tunnel Release……………………………… 8-48
8.4.3.2 Procedure Volumes………………………………….. 8-50
Exhibit 8-1: Open Fracture Reduction with Internal Fixation,
Procedure Volumes Forecast, 2011-2018………………………………….. 8-8
Exhibit 8-2: Knee Arthroplasty, Procedure Volumes Forecast, 2011-2018……… 8-12
Exhibit 8-3: Unicompartmental Knee Arthroplasty,
Procedure Volumes Forecast, 2011-2018………………………………… 8-14
Exhibit 8-4: Hip Arthroplasty, Procedure Volumes Forecast, 2011-2018………… 8-19
Exhibit 8-5: Discectomy, Procedure Volumes Forecast, 2011-2018………………. 8-24
Exhibit 8-6: Spinal Decompression, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 8-27
Exhibit 8-7: Spinal Fusion and Refusion, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 8-32
Exhibit 8-8: Arthroscopic Knee Surgery, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 8-35
Exhibit 8-9: Meniscectomy and Meniscal Repair,
Procedure Volumes Forecast, 2011-2018………………………………… 8-38
Exhibit 8-10: Anterior Cruciate Ligament Reconstruction,
Procedure Volumes Forecast, 2011-2018………………………………… 8-41
Exhibit 8-11: Arthroscopic Shoulder Surgery, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 8-47
Exhibit 8-12: Carpal Tunnel Release, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 8-51
9. UROLOGIC SURGICAL PROCEDURES……………………………………………. 9-1
9.1 Incontinence Management ………………………………………………………. 9-1
9.1.1 Procedure Volumes………………………………………………….. 9-4
9.2 Nephrectomy …………………………………………………………………………. 9-5
9.2.1 Procedure Volumes………………………………………………….. 9-7
9.3 Prostate Procedures……………………………………………………………….. 9-9
9.3.1 Radical Prostatectomy ……………………………………………. 9-11
9.3.1.1 Procedure Volumes………………………………….. 9-14
9.3.2 Transurethral Resection of the Prostate…………………….. 9-14
9.3.2.1 Procedure Volumes………………………………….. 9-16
9.3.3 Directed Energy-Based Treatment for
Benign Prostatic Hyperplasia …………………………………… 9-17
9.3.3.1 Transurethral Microwave Thermotherapy…….. 9-19
9.3.3.2 Transurethral Needle Ablation……………………. 9-20
9.3.3.3 Laser Therapies for Benign
Prostatic Hyperplasia ……………………………….. 9-21
9.3.3.3.1 Diode Laser Vaporization
of the Prostate ……………………… 9-22
9.3.3.3.2 Holmium Laser Enucleation
of the Prostate ……………………… 9-22
9.3.3.3.3 Photoselective Vaporization
of the Prostate ……………………… 9-23
9.3.3.3.4 Thulium Laser Vapoenucleation
of the Prostate ……………………… 9-24
9.3.3.4 Procedure Volumes………………………………….. 9-24
9.4 Urinary Stone Removal …………………………………………………………. 9-25
9.4.1 Extracorporeal Shock Wave Lithotripsy……………………… 9-25
9.4.2 Endoscopic Stone Removal …………………………………….. 9-27
9.4.3 Percutaneous Nephrolithotomy ………………………………… 9-28
9.4.4 Intracorporeal Lithotripsy…………………………………………. 9-29
9.4.4.1 Electrohydraulic Lithotripsy ……………………….. 9-29
9.4.4.2 Laser Lithotripsy………………………………………. 9-30
9.4.4.3 Pneumatic Lithotripsy ……………………………….. 9-31
9.4.4.4 Ultrasonic Lithotripsy………………………………… 9-32
9.4.5 Open Surgery………………………………………………………… 9-32
9.4.6 Procedure Volumes………………………………………………… 9-33
Exhibit 9-1: Suspension and Sling Procedures for Stress Urinary Incontinence,
Procedure Volumes Forecast, 2011-2018………………………………….. 9-6
Exhibit 9-2: Nephrectomy, Procedure Volumes Forecast, 2011-2018……………… 9-8
Exhibit 9-3: Radical Prostatectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 9-15
Exhibit 9-4: Transurethral Resection of Prostate,
Procedure Volumes Forecast, 2011-2018………………………………… 9-18
Exhibit 9-5: Directed Energy-Based Treatment for Benign Prostatic
Hyperplasia, Procedure Volumes Forecast, 2011-2018 ……………… 9-26
Exhibit 9-6: Urinary Stone Removal, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 9-34
10. MISCELLANEOUS SURGICAL PROCEDURES ……………………………….. 10-1
10.1 Breast Procedures………………………………………………………………… 10-1
10.1.1 Breast Biopsy ………………………………………………………… 10-1
10.1.1.1 Surgical Biopsy………………………………………… 10-3
10.1.1.2 Percutaneous Biopsy ……………………………….. 10-4
10.1.1.3 Vacuum-Assisted Biopsy…………………………… 10-5
10.1.1.4 Procedure Volumes………………………………….. 10-6
10.1.2 Lumpectomy………………………………………………………….. 10-6
10.1.2.1 Procedure Volumes………………………………….. 10-9
10.1.3 Mastectomy…………………………………………………………… 10-9
10.1.3.1 Prophylactic Mastectomy ………………………… 10-12
10.1.3.2 Simple Mastectomy………………………………… 10-12
10.1.3.3 Radical and Modified Radical Mastectomy…. 10-13
10.1.3.4 Procedure Volumes………………………………… 10-13
10.2 Ear, Nose, and Throat Procedures………………………………………… 10-13
10.2.1 Sinus Procedures …………………………………………………. 10-15
10.2.1.1 Procedure Volumes………………………………… 10-17
10.2.2 Tonsillectomy and Adenoidectomy………………………….. 10-19
10.2.2.1 Procedure Volumes………………………………… 10-22
10.2.3 Tracheotomy ……………………………………………………….. 10-22
10.2.3.1 Procedure Volumes………………………………… 10-25
10.3 Splenectomy………………………………………………………………………. 10-25
10.3.1 Procedure Volumes………………………………………………. 10-27
Exhibit 10-1: Breast Biopsy, Procedure Volumes Forecast, 2011-2018…………… 10-7
Exhibit 10-2: Lumpectomy, Procedure Volumes Forecast, 2011-2018…………… 10-10
Exhibit 10-3: Mastectomy, Procedure Volumes Forecast, 2011-2018……………. 10-14
Exhibit 10-4: Sinus Surgery, Procedure Volumes Forecast, 2011-2018…………. 10-18
Exhibit 10-5: Tonsillectomy and Adenoidectomy,
Procedure Volumes Forecast, 2011-2018………………………………. 10-23
Exhibit 10-6: Tracheotomy, Procedure Volumes Forecast, 2011-2018 ………….. 10-26
Exhibit 10-7: Splenectomy, Procedure Volumes Forecast, 2011-2018 ………….. 10-28
Figure: On-Pump and Off-Pump Coronary Artery Bypass Graft Surgery, Procedure Volumes Forecast, 2014-2020
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