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Related Experiment Videos

Variation profiles of common surgical procedures

J D Birkmeyer1, S M Sharp, S R Finlayson

  • 1Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH, USA.

Surgery
|November 21, 1998
PubMed
Summary
This summary is machine-generated.

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Surgical procedure rates vary significantly by region, with discretionary procedures showing the most variation. Efforts to standardize care should focus on these high-variation procedures to prevent overuse or underuse.

Area of Science:

  • Health Services Research
  • Surgical Outcomes
  • Geographic Health Disparities

Background:

  • Significant geographic variation exists in surgical procedure rates.
  • Previous studies have not systematically compared variation profiles across different surgical procedures.
  • Understanding regional variation is crucial for healthcare quality assessment.

Purpose of the Study:

  • To examine current patterns of regional variation in the rates of common surgical procedures.
  • To identify which surgical procedures exhibit the highest and lowest rates of geographic variation.

Main Methods:

  • Analysis of Medicare data from 1995 for patients aged 65-99, excluding HMO enrollees.
  • Calculation of inpatient procedure rates for 11 common surgeries across 306 US hospital referral regions (HRRs).

Related Experiment Videos

  • Assessment of variability using outlier regions (rates <50% or >150% national average) and highest-to-lowest rate ratios.

    • Main Results:

    • Marked differences in variability were observed across procedures.
    • Low variation (1.9-2.9 fold): hip fracture repair, colorectal cancer resection, cholecystectomy.
    • Intermediate variation (3.5-4.7 fold): CABG, prostatectomy, mastectomy, hip replacement.
    • High variation (6.5-10.1 fold): lower extremity revascularization, carotid endarterectomy, back surgery, radical prostatectomy.

    Conclusions:

    • Surgical procedure rates display substantial geographic variability.
    • Discretionary procedures demonstrate the highest variation in utilization rates.
    • Focusing on high-variation procedures can help improve clinical decision-making consensus and reduce potential overuse or underuse.