Trends in Vascular Surgery Activity: Results From the Spanish National Inpatient Registry Over an 18-Year Period (2005 to 2022) and Future Plan

Abstract

Purpose. In this manuscript, the authors aim to identify the main trends in diagnosis, procedures, and costs of angiology and vascular surgery in Spain over a period of 18 years, with a time horizon in 2035. Methods. In this retrospective observational population-based study, data from the Spanish Minimum Basic Data Set were reviewed. All vascular patient hospitalizations reported from 2005 to 2022 were analyzed. Age and sex-adjusted incidence rates were calculated for all diagnostics and procedures. Generalized linear models were used for trend analysis. Results. Between 2005 and 2022, the adjusted rate of diagnostics in vascular surgery departments increased from 102.5 per 100,000 population in 2005 (confidence interval [CI],95%: 101.5-103.4) to 237.1 per 100,000 population (CI, 95%: 235.7-238.4) in 2022. The annual linear trend in total rate of diagnosis estimated shows a similar increase in all groups, with no interaction effect by sex or age (inter-rater reliability [IRR] = 1.02; CI, 95%: 1.01-1.04, P = .001). The adjusted rate of procedures reported in vascular surgery departments increased from 215.4 per 100,000 population (CI, 95%: 214.0-216.8) in 2005 to 521.7 (CI, 95%: 519.7-523.7) in 2022. The annual linear trend in total rate of procedures estimated was higher in groups under age 64 (P = .001), with no interaction effect by sex: IRR = 1.05 (CI, 95%: 1.04-1.07) in men and 1.07 (CI, 95%: 1.05-1.10) in women, while in groups over age 64, IRR = 1.01 (CI, 95%: 0.99-1.03) and 1.03 (CI, 95%: 1.01-1.05), respectively. The mean of all patient refined costs in 2016 was $4929.09 (€4200.44) and in 2022 was $5711.78 (€4867.43). The estimated annual increase adjusted by age and sex was $156.49 (€133.36) (CI, 95%: -2.60 to 269.30, P = .054). Conclusions. In Spain, despite the advances that have taken place in controlling vascular risk factors, the incidence rate of diagnosis and vascular procedures increased regardless of age and sex. Recommendations to face the growing demand and complexity of vascular surgery services include a yearly growth of the health care workforce until 2035 and the development and application of more accurate quality indicators for measuring vascular care and health outcomes.