Geographical differences in upper abdominal resectional surgery and high-volume procedures in Sweden during 2009-2011

Upper abdominal surgery comprises many different procedures, from major resectional surgery on the esophagus, stomach, liver, and pancreas, to high-volume operations such as cholecystectomy and bariatric surgery. The aim of the present study was to evaluate geographical differences, if any, in number of procedures performed per capita among the 6 healthcare regions and the 21 Swedish counties, responsible for the health care of its inhabitants.

Data on resectional surgery and high-volume procedures were collected for the study period (2009-2011) from the Swedish National Patient Register. Annual number of procedures and procedures performed per 100,000 inhabitants was registered based on the place of residence of patients.

In the six healthcare regions, the number of resections per 100,000 inhabitants on the esophagus varied from 1.8 to 3.9, stomach 5.3-6.7, liver 6.7-13.2, and pancreas 4.9-8.3. Corresponding figures for cholecystectomies were 146.7-191.3 and for bariatric surgery 33.1-97.4. The southeast region had the highest incidence of major resectional surgery, except for gastric resections. A high number of cholecystectomies were performed in all regions. Bariatric surgery was most common in the Stockholm region. At county level, the variations were larger, particularly for liver surgery and high-volume procedures.

Significant geographical differences were observed between the six healthcare regions and at county level, when studying the number of procedures performed per 100,000 inhabitants. We believe that this reflects local traditions in selection of patients for resectional surgery and differences in capacity for meeting the high demand for bariatric surgery.