Variation profiles of common surgical procedures

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).
• 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.