Regional Variation in Surgical Procedure Rates: Going Beyond Description

For many surgical procedures, location matters. Where a patient resides has an important influence on the likelihood that they will have surgery for a particular condition. In the United States, variations between high-use regions and low-use regions of up to 4 times have been reported for knee and hip arthroplasty, with even larger variations for back surgery, carotid endarterectomy, and prostatectomy. Similar regional variations have been reported in Canada, the United Kingdom, Europe, and Australia. Variation is greatest for procedures that are discretionary, either because they are symptom driven or prophylactic, and that address conditions that lack highly effective nonsurgical treatments.