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Understanding Variations in the Use of Surgery

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Success in Academic Surgery: Health Services Research

Part of the book series: Success in Academic Surgery ((SIAS))

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Abstract

This chapter details the origins of the study of variations in health care, with special attention to variations in the use, indications, and outcomes in surgery. We review the initial studies that demonstrated the value of this methodology, and describe how the study of variations allows insight into surgical practice. Finally, we will review the ways limiting variation can improve patient outcomes across a variety of surgical specialties, and inform health policy efforts aimed at limiting disparities in the use and outcomes of surgical procedures.

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References

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Landmark Papers

  • Birkmeyer JD, Sharp SM, Finlayson SR, Fisher ES, Wennberg JE. Variation profiles of common surgical procedures. Surgery. 1998;124:917–23. This paper was the first to demonstrate that small area analysis of variations in surgical practice was feasible on a national scale, and introduced the study of regional variation to surgeons.

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  • Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in medicare spending. Part 1: The content, quality, and accessibility of care. Ann Intern Med. 2003a;138:273–87.

    Article  PubMed  Google Scholar 

  • Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in medicare spending. Part 2: Health outcomes and satisfaction with care. Ann Intern Med. 2003b;138:288–98. This two-part manuscript is among the most commonly referenced large studies of variation in Medicare spending and its effect on outcomes.

    Google Scholar 

  • Wennberg J, Gittelsohn. Small area variations in health care delivery. Science. 1973;182:1102–08. This was the first prominent publication demonstrating that small area analysis could identify important variations in the use and outcomes of medical care.

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Author information

Authors and Affiliations

  1. Center for the Evaluation of Surgical Care (CESC), Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03765, USA

    Philip P. Goodney M.D., M.S. (Director, Co-Director)

  2. VA Outcomes Group, White River Junction, VA Medical Center, White River Junction, VT, 05059, USA

    Philip P. Goodney M.D., M.S. (Director, Co-Director)

Authors
  1. Philip P. Goodney M.D., M.S.
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Corresponding author

Correspondence to Philip P. Goodney M.D., M.S. .

Editor information

Editors and Affiliations

  1. Associate Chair for Faculty Development, Department of Surgery, Henry King Ransom Professor of Surgery Chief, Division of Minimally Invasive Surgery, University of Michigan, Ann Arbor, Michigan, USA

    Justin B. Dimick

  2. Associate Professor of Surgery, WARF Professor of Surgical Research Director, Wisconsin Surgical Outcomes Research (WiSOR), Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA

    Caprice C. Greenberg

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Goodney, P.P. (2014). Understanding Variations in the Use of Surgery. In: Dimick, J., Greenberg, C. (eds) Success in Academic Surgery: Health Services Research. Success in Academic Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-4718-3_3

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  • DOI: https://doi.org/10.1007/978-1-4471-4718-3_3

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4717-6

  • Online ISBN: 978-1-4471-4718-3

  • eBook Packages: MedicineMedicine (R0)

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