ABSTRACT
Although the number of surgical procedures performed annually in the United States is not precisely known, over 32 million were performed during 2006, with about one fourth taking place in the hospital in-patient setting and the rest in ambulatory surgery clinics, physicians’ offices, and hospitalbased, out-patient surgical centers ( 2 ). Healthy patients deemed at low risk for adverse events are usually selected for out patient procedures. However, the number of surgical mishaps and misadventures is subject to increase with continued growth in the volume of out-patient procedures and less intense oversight of safety measures in these settings. The precise number of in-patient female urology and urogynecology procedures performed in the United States, the European Union, or worldwide in also not known. Oliphant et al. ( 3 ) found that age-adjusted rates for in-patient stress urinary incontinence (SUI) procedures performed in the United States between 1979 and 2004 more than doubled from 0.64 to 1.60 per 1000 woman. Their analysis underestimates the true overall and age-adjusted rates of such procedures because the National Hospital Discharge Survey (NHDS) database used for this study excludes federal, military, and Veteran hospital discharge information. Yet, both the overall and age-adjusted rates will likely increase as the population ages since about 20% of the population is expected to be 65 or more years by 2030, the majority being women ( 4 ). Although precise numbers of female urology and urogynecology out-patient procedures are not known, Boyles et al. ( 5 ) found that female urinary incontinence procedures performed in the out-patient setting doubled between 1994 and 1996 in the United States. Data reflecting more recent experience will soon be available ( 6 ) but such procedures are projected to increase in the United States and globally as the population ages, especially in industrialized countries ( 1 ). The number of surgical adverse events likely will
increase given the projected growth in the aging population with potential co-morbidities, the projected increase in outpatient surgical procedures, and the increasing variety of surgical options, such as minimally-invasive endoscopic procedures, mid-urethral procedures, and injectable implants or bulking agents.
