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miscellaneous diagnostic and therapeutic procedures, obstetrical procedures, operations on the cardiovascular system, and operations of the digestive system (table 10).

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    One in four procedures performed on females were obstetrical, and over 1 in 10 procedures were cardiovascular (figure 4).

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      Twenty-three percent of all procedures performed on males were cardiovascular, 14 percent were digestive, and 11 percent were musculoskeletal (figure 4).

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      Males had more cardiovascular procedures than females (3.9 million and 2.9 million, respectively) (table 10). The rate of cardiovascular procedures performed on males was

      • 276.7

        per 10,000 population compared with 196.0 per 10,000 population for females (table 11).

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      Females had more operations on the digestive system than males (3.3 million and 2.4 million, respectively) (table 10). The rate of digestive procedures for females was 224.7 per 10,000 population compared with

      • 170.4

        per population for males (table 11).

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      Males had over 1.1 million arteriographies and angiocardiographies, 763,000 cardiac catherizations, and 696,000 transfusions of blood or blood components, and 592,000 respiratory therapy procedures while hospitalized (table 10).

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      Females had 1.2 million procedures for the repair of current obstetric laceration, 1.1 million cesarean sections, 914,000 transfusions of blood or blood components, and 884,000 procedures for artificial rupture of membranes while hospitalized (table 10).


Data source

The National Hospital Discharge Survey (NHDS) collects data from a sample of inpatient records acquired from a national sample of hospitals. Because persons with multiple discharges during the year may be sampled more than once, estimates are

Advance Data No. 359 + July 8, 2005

Figure 4. Percent distribution of all-listed procedures for hospitalized patients by sex: United States, 2003

for discharges, not persons. Only hospitals with an average length of stay of fewer than 30 days for all patients and general hospitals or children’s general hospitals are included in the survey. Federal, military, and Department of Veterans Affairs hospitals, as well as hospital units of institutions (such as prison hospitals) and hospitals with fewer than six beds staffed for patient use, are excluded.

Prior to 1988, the NHDS was based on a two-stage design. The survey was redesigned in 1988 (31). The new sample design uses a modified, three- stage design. Units selected at the first stage consist of either hospitals or geographic areas, such as counties, groups of counties, or metropolitan statistical areas in the 50 States and the District of Columbia. Within a sampled geographic area, hospitals are selected. Finally, at the last stage, discharges are selected within sampled hospitals using systematic random sampling. Until 2003, the hospital sampling frame for the redesigned survey was constructed from the SMG Hospital Market Database (32). Beginning in 2003, the sample frame was constructed from the products of Verispan, L.L.C., specifically their ‘‘Healthcare Market Index, updated May 15, 2003’’ and their ‘‘Hospital Market Profiling Solution, Second Quarter 2003.’’ These two products were formerly known as the SMG Hospital Market Database. The

hospital sampling frame and sample are updated every 3 years (31).

For 2003, the sample consisted of 501 hospitals, of which 22 were found to be out of scope (ineligible) because they had gone out of business or otherwise failed to meet the criteria for the NHDS universe. Of the 479 in-scope (eligible) hospitals, 426 responded to the survey. Data were collected for approximately 320,000 discharges from the 426 responding hospitals.

Two data collection procedures are used in the survey. One is a manual system in which sample selection and medical transcription from the hospital records to abstract forms are performed by the hospital’s staff or by staff of the U.S. Census Bureau on behalf of NCHS. Completed forms are sent to NCHS for coding, editing, and estimation.

The other data collection procedure is an automated system in which NCHS purchases machine-readable medical record data from commercial organizations, State data systems, hospitals, or hospital associations. Records from these sources are systematically sampled by NCHS. In 2003, approximately 41 percent of respondent hospitals provided data through the automated system. A detailed report on the design and operation of the NHDS has been published (31).

The medical abstract form (figure 5) and the automated data contain items

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