Surgery Needs by Generation
Surgery is a fixture of modern medicine, with techniques continuously advancing in order to be able to treat more conditions. There are approximately 35 million inpatient hospital stays in the United States each year,1 and more than one quarter involve at least one surgical procedure.2 Due to the growing and aging population, it is a significant public health interest to understand the healthcare needs of each generation and how those needs change across age groups, particularly as they relate to surgery.
The Agency for Healthcare Research and Quality (AHRQ), a US government agency that sits within the Department of Health and Human Services, collects and publishes data on these trends as part of its Healthcare Cost and Utilization Project. They provide a valuable window into surgery needs by generation.
In 2018, when the AHRQ most recently published its report on inpatient surgeries, 9.6 million inpatient stays involved operating room (OR) procedures, with a total of 14.4 million procedures that together cost $210 billion.3 27% of inpatient stays involved a surgical procedure, and these stays were longer and more than twice as costly as those without such procedures. Across all age groups and demographics, the most common OR procedures were cesarean section, knee arthroplasty, and perineal muscle laceration repair.
When broken down by age group, however, clear trends in surgeries begin to emerge. The most common procedure in the 0–17 age group was the appendectomy; appendicitis most commonly occurs in childhood, early adolescence, or early adulthood.4 The other leading operations in this age group include bone fixation outside of the extremities and perineal muscle laceration repair, though these were much less common. Overall, OR procedures in this age group remain rare: for girls, only 633.3 per 100,000 individuals, or 1 in 158, undergo an operation, and for boys, only 717.3 per 100,000, or 1 in 139.
In the 18–44 group, caesarean sections were by far the most common surgery, with 1 in every 50 women in this age range receiving one. They are also the reason women in this group are four times more likely than men to have an OR procedure. The next most common procedure for women is perineal muscle laceration repair, followed by fallopian tube ligation and excision. Fixation of leg and foot bones, appendectomy, and subcutaneous tissue and fascia excision are the most common surgeries for men, though all are far less common than the operations women most commonly receive.
As both men and women age through their 40s, 50s, and 60s, orthopedic procedures, like knee and hip arthroplasty and spine fusion, become increasingly common, according to the AHRQ data. Interestingly, percutaneous coronary intervention was the most common surgery for men ages 45–64 but was not among the top five for women. Finally, in the 65–74 and 75+ age groups, orthopedic surgeries remain common, with the inclusion of femur fixation, which may be needed as a result of falls.
Surgeries common among older adults collectively cost patients more money than other surgeries, even though the average cost per operation is relatively low compared to other complex operations. For example, the average total cost of a spine fusion, including the hospital stay, was $33,800, which does not make the list of the top 20 most expensive OR procedures.
The most expensive surgery, a heart transplant, had an average cost of $304,300 per stay, but only 3,300 such procedures were performed in 2018. In contrast, there were 418,700 spinal fusions, costing a total of $14.1 billion. The next most expensive procedures, measured by total expenditure among US patients, were knee and hip arthroplasty.
However, inpatient data does not capture the full range of surgical care and is skewed towards major procedures and higher acuity patients. AHRQ also collects data on outpatient procedures, and they similarly provide insight into how the surgery needs of the general population change across generations. In 2019, the most recent year for which AHRQ collected this data,5 there were 11.9 million major outpatient procedures in the US.
In the 0–17 age group, the most common ones were tonsillectomy/adenoidectomy and myringotomy—incision into the eardrum to relieve pressure or drain fluid—while frequent procedures in the 18–44 range included hysterectomy, gallbladder removal, and procedures on the muscles and tendons, like arthroscopic rotator cuff repair.
For both men and women, muscle and tendon procedures were the most common outpatient procedures in the 45–64 age range, while lens and cataract procedures were the fifth-most common. By the time men and women reached 65+, lens and cataract procedures had become the most common outpatient procedure.
References
1. Reid, L. D. & Fang, Z. Changes in Hospitalizations and In-Hospital Deaths in the Initial Period of the COVID-19 Pandemic (April–December 2020), 29 States. in Healthcare Cost and Utilization Project (HCUP) Statistical Briefs (Agency for Healthcare Research and Quality (US), Rockville (MD), 2006).
2. McDermott, K. W., Freeman, W. J. & Elixhauser, A. Overview of Operating Room Procedures During Inpatient Stays in U.S. Hospitals, 2014. in Healthcare Cost and Utilization Project (HCUP) Statistical Briefs (Agency for Healthcare Research and Quality (US), Rockville (MD), 2006).
3. Overview of Operating Room Procedures During Inpatient Stays in U.S. Hospitals, 2018 #281. https://hcup-us.ahrq.gov/reports/statbriefs/sb281-Operating-Room-Procedures-During-Hospitalization-2018.jsp.
4. Lotfollahzadeh, S., Lopez, R. A. & Deppen, J. G. Appendicitis. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2026).
5. Overview of Major Ambulatory Surgeries Performed in Hospital-Owned Facilities, 2019 #287. https://hcup-us.ahrq.gov/reports/statbriefs/sb287-Ambulatory-Surgery-Overview-2019.jsp.