ANN ARBOR, Mich. –A patient’s odds of undergoing surgery often depends more on where he or she lives than on their clinical circumstances, according to a two-part series exploring variation in surgery use published today in the London-based journal The Lancet.
The first series authored by University of Michigan Health System surgeon John D. Birkmeyer, M.D., and colleagues suggests regional variation in the use of surgical procedures exists in many different countries, yet patient demand and differences in diagnostic practices do not appear to have much of an effect on these differences.
Instead, Birkmeyer, professor in the Department of General Surgery and researcher at the Center for Healthcare Outcomes and Policy at the University of Michigan, cautions that the motivations and beliefs of doctors are the most important reasons for surgical variation.
Reducing variation will require systematic efforts to ensure that treatment decisions are driven by the well-informed preferences of individual patients.
In the second series paper, physicians at John Radcliffe Hospital, Oxford, U.K., examine in detail strategies to reduce regional variation in the provision of surgery, arguing that addressing unwarranted regional variation could have enormous potential to reduce avoidable deaths and illness, as well as unnecessary use of resources.
Those authors suggest that variation in surgical provision needs to be more widely recognized, and its causes better understood.
Although existing lack of evidence makes the evaluation of different approaches to reducing variation difficult, the authors, led by Radcliffe’s Peter McCullough, advise that while some system-level changes – especially changes to funding structure – can have major effects on the use of surgery, these changes can be difficult to control, and may even reduce the quality of care.
Reference:"Understanding of regional variation in the use of surgery," The Lancet, Vol. 382, Issue 9898, 28 September 2013.