The Rising Procedural Burden in Vascular Surgery: An 8-Year Nationwide Population-Based Analysis with Projections to 2035

Abstract

Objective To quantify the evolving procedural burden in vascular surgery within a nationwide health system and to estimate future workload projections through 2035. Methods A retrospective, population-based study was conducted using the Spanish National Hospital Discharge Registry (RAE-CMBD) from 2016 to 2023. All surgical and endovascular procedures performed in Vascular Surgery Departments were identified and classified by type. Age- and sex-adjusted incidence rates per 100,000 inhabitants were calculated using direct standardization. Temporal trends were assessed using multivariable Poisson regression models with population size as an offset. Linear projections of procedural volume were estimated through 2035 based on observed annual trends. Results Between 2016 and 2023, the adjusted incidence of vascular procedures increased from 266.8 to 380.4 per 100,000 population, representing a 43% relative increase. Growth was consistent across age and sex groups (IRR 1.04; 95% CI 1.00–1.08; p = 0.049). The largest annual increases were observed in thoracic endoprosthesis implantation (+13%), venous stenting (+10%), endovascular lower limb revascularization (+9%), varicose vein interventions (+8%), and endovascular aortoiliac revascularization (+7%) (all p < 0.01). Projections indicate a further 59% increase in overall procedural volume by 2035 compared with 2023. Conclusions Vascular surgery is experiencing a sustained and clinically significant increase in procedural demand, driven largely by expanding endovascular activity. If current trends continue, workload will rise substantially over the next decade. These findings highlight the need for anticipatory workforce planning, training adaptation, and resource allocation to ensure the sustainable delivery of vascular surgical care.