Changing trends in the use and costs of procedures performed by neurosurgeons in the United States.

Understanding the changes in procedure use and total cost associated with the care of patients is important to the practice of neurosurgery. This information helps guide policies regarding workforce, training, continuing education, and research. Previous work detailing neurosurgical practice has been limited by focusing on specific procedures (e.g., craniotomy, carotid endarterectomy, etc.) or by using nonpopulation-based analyses or surveys of professional society members (4–6, 8, 9). Such investigations may not accurately capture the change in overall practice within the United States or allow for comparison of changes across multiple procedures. Periodic analysis of health care use and services is vital to understand the changes in supply and demand for specific types of health services, changes in the dollars spent for those services, and potential areas of over/under use or spending. Such analysis is particularly important for neurosurgery because it is a dynamic, technology-driven field, the services provided have a high human impact and often a high cost, and the supply of practitioners is stable and fixed. This investigation provides population-based estimates and overall trends in discharge rates and hospital charges for inpatient procedures commonly performed by neurosurgeons in the United States. In doing so, it will serve to guide future workforce needs, resource allocation, training and education structures, and research priorities within neurosurgery.