Trends in vascular surgery activity: results from an 18-year period (from 2005 to 2022) and need for specialists by 2035

Abstract

Introduction: human resource planning for health is extremely important to adequately respond to the challenges of the specialty and thus assess both our activity and the vascular medical workforce. Objectives: to identify trends in diagnosis, procedures and costs of the specialty of Angiology and Vascular Surgery in Spain over a period of 18 years and analyze the number of specialists needed with a time horizon set in 2035. Methods: we conducted a retrospective, observational, population-based study to analyze the activity of vascular surgery services in Spain and a cross-sectional study to analyze the current situation of the workforce in said services. Material: annual activity data in vascular surgery departments from 2005 through 2022 from the national Minimum Basic Data Set (MBDS) available at https://pestadistico.inteligenciadegestion.sanidad.gob.es/PUBLICOSNS were analyzed, as well as the APR (All refined patient costs) cost data, available since 2016. Age- and sex-adjusted crude incidence rates were calculated for all diagnoses and procedures. Generalized linear models (GLM) were used to estimate trends. A survey was conducted among SEACV members and an estimate was made based on headcounts (number of vascular surgeons) and full-time equivalents (FTE) of vascular surgeons. Results: between 2005 and 2022, the adjusted rate of diagnoses increased from 102.5 (95 % CI, 101.5-103.4) per 100,000 inhabitants in 2005 up to 237.1 per 100,000 inhabitants (95 % CI, 235.7-238.4) in 2022. The annual linear trend of the estimated total diagnosis rate shows a similar increase in all groups, with no interaction effect by sex or age (IRR, 1.02, 95 % CI, 1.01-1.04, p = 0.001).The adjusted rate of procedures increased from 215.4 (95 % CI, 214216.8) per 100,000 inhabitants in 2005 up to 521.7 (95 % CI, 519.7-523.7) in 2022. 2022.The annual lineartrend in the estimated total procedure rate was higher in < 65 years (p = 0.001), with no interaction effect by sex: IRR, 1.05 (95 % CI, 1.04-1.07) in men and 1.07 (95 % CI, 1.05-1.1) in women, while in > 65 years, IRR, 1.01 (95 % CI, 0.99-1.03) and 1.03 (95 % CI, 1.01-1.05) respectively. The mean APR cost in 2016 was <euro>4,200.44 vs <euro>4,867.43 in 2022. The estimated annual increase adjusted for age and sex was 133.36 (95 % CI,-2.6-269.3, p = 0.054). The growth in demand for stroke specialists between 2023-2035 (based on a system dynamics model) will be 45 %. From the current 985 up to the 1,430 that will be needed in 2035 according to the trends defined in diagnoses and procedures. Compared to a 19.6 % growth in supply for the same period up to the 1,169 estimated for 2035. Conclusions: this nationwide study shows that there is an upward trend in the incidence of vascular disease.There are very few studies worldwide that perform calculations in FTE, despite being the international recommendation. There is a difference in the calculation of the needs for vascular surgeons depending on whether the calculation is made one way or another, with FTE being a more complete-also a more complex-form of calculation.