Understanding of regional variation in the use of surgery

John D. Birkmeyer, Bradley N. Reames, Peter McCulloch, Andrew J. Carr, W. Bruce Campbell, John E. Wennberg

Research output: Contribution to journalReview article

240 Scopus citations

Abstract

The use of common surgical procedures varies widely across regions. Differences in illness burden, diagnostic practices, and patient attitudes about medical intervention explain only a small degree of regional variation in surgery rates. Evidence suggests that surgical variation results mainly from differences in physician beliefs about the indications for surgery, and the extent to which patient preferences are incorporated into treatment decisions. These two components of clinical decision making help to explain the so-called surgical signatures of specific procedures, and why some consistently vary more than others. Variation in clinical decision making is, in turn, affected by broad environmental factors, including technology diffusion, supply of specialists, local training frameworks, financial incentives, and regulatory factors, which vary across countries. Better scientific evidence about the comparative effectiveness of surgical and non-surgical interventions could help to mitigate regional variation, but broader dissemination of shared decision aids will be essential to reduce variation in preference-sensitive disorders.

Original languageEnglish (US)
Pages (from-to)1121-1129
Number of pages9
JournalThe Lancet
Volume382
Issue number9898
DOIs
StatePublished - 2013

ASJC Scopus subject areas

  • Medicine(all)

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    Birkmeyer, J. D., Reames, B. N., McCulloch, P., Carr, A. J., Campbell, W. B., & Wennberg, J. E. (2013). Understanding of regional variation in the use of surgery. The Lancet, 382(9898), 1121-1129. https://doi.org/10.1016/S0140-6736(13)61215-5