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Canadian Medical Association Journal logoLink to Canadian Medical Association Journal
. 1984 Jul 15;131(2):111–115.

Five-year study of surgical rates in Ontario's counties.

E Vayda, J M Barnsley, W R Mindell, B Cardillo
PMCID: PMC1483265  PMID: 6744157

Abstract

The surgical rates for eight operations (hysterectomy, tonsillectomy/adenoidectomy, cholecystectomy, prostatectomy, appendectomy, mastectomy, colectomy and cesarean section) done in Ontario's 44 counties from 1973 to 1977 were examined. There was considerable variation among the counties for all the operations studied, although the degree of intercounty variation decreased over the 5 years. Differences in resources (hospital beds and surgeons) explained little of the variation in the rates, but this may be because people crossed county lines for certain operations. Although some counties had consistently high or low rates for individual operations during the 5-year period, only four had consistently high rates for four or more operations, and only five had consistently low rates for four or more. The five counties with teaching health science centres had the highest ratios of specialists and surgeons to population, and, with the exception of one county in 1973, had above-average numbers of hospital beds. Despite the greater resources in these counties, their residents had consistently low rates for cholecystectomy, appendectomy, mastectomy and tonsillectomy/adenoidectomy. However, three of these counties had the highest rates for cesarean section. The variation in the rates is likely due to lack of agreement about indications for surgery or to variation in the use of technology rather than to differences in the incidence or prevalence of disorders.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cageorge S. M., Roos L. L., Jr, Danzinger R. Gallbladder operations: a population-based analysis. Med Care. 1981 May;19(5):510–525. doi: 10.1097/00005650-198105000-00004. [DOI] [PubMed] [Google Scholar]
  2. Crymble C., Vayda E. Surgical rates in the Canadian Forces and the general Canadian population. Clin Invest Med. 1981;4(1):37–40. [PubMed] [Google Scholar]
  3. Gracie W. A., Ransohoff D. F. The natural history of silent gallstones: the innocent gallstone is not a myth. N Engl J Med. 1982 Sep 23;307(13):798–800. doi: 10.1056/NEJM198209233071305. [DOI] [PubMed] [Google Scholar]
  4. Lewis C. E. Variations in the incidence of surgery. N Engl J Med. 1969 Oct 16;281(16):880–884. doi: 10.1056/NEJM196910162811606. [DOI] [PubMed] [Google Scholar]
  5. Lichtner S., Pflanz M. Appendectomy in the Federal Republic of Germany: epidemiology and medical care patterns. Med Care. 1971 Jul-Aug;9(4):311–330. doi: 10.1097/00005650-197107000-00003. [DOI] [PubMed] [Google Scholar]
  6. Mindell W. R., Vayda E., Cardillo B. Ten-year trends in Canada for selected operations. Can Med Assoc J. 1982 Jul 1;127(1):23–27. [PMC free article] [PubMed] [Google Scholar]
  7. Pearson R. J., Smedby B., Berfenstam R., Logan R. F., Burgess A. M., Jr, Peterson O. L. Hospital caseloads in Liverpool, New England, and Uppsala. An international comparison. Lancet. 1968 Sep 7;2(7567):559–566. doi: 10.1016/s0140-6736(68)92423-9. [DOI] [PubMed] [Google Scholar]
  8. Rutkow I. M., Gittelsohn A. M., Zuidema G. D. Surgical decision making. The reliability of clinical judgment. Ann Surg. 1979 Sep;190(3):409–419. doi: 10.1097/00000658-197909000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Shah C. P. Anaesthesia for day-care surgery: a symposium (I). Day-care surgery in Canada: evolution, policy and experience of provinces. Can Anaesth Soc J. 1980 Jul;27(4):399–405. doi: 10.1007/BF03007463. [DOI] [PubMed] [Google Scholar]
  10. Stockwell H., Vayda E. Variations in surgery in Ontario. Med Care. 1979 Apr;17(4):390–396. doi: 10.1097/00005650-197904000-00007. [DOI] [PubMed] [Google Scholar]
  11. Vayda E., Mindell W. R., Mueller C. B., Yaffe B. Measuring surgical decision-making with hypothetical cases. Can Med Assoc J. 1982 Aug 15;127(4):287–290. [PMC free article] [PubMed] [Google Scholar]
  12. Vayda E., Mindell W. R., Rutkow I. M. A decade of surgery in Canada, England and Wales, and the United States. Arch Surg. 1982 Jun;117(6):846–853. doi: 10.1001/archsurg.1982.01380300086019. [DOI] [PubMed] [Google Scholar]
  13. Vayda E., Mindell W. R. Variations in operative rates: what do they mean? Surg Clin North Am. 1982 Aug;62(4):627–639. doi: 10.1016/s0039-6109(16)42783-0. [DOI] [PubMed] [Google Scholar]
  14. Wennberg J. E., Barnes B. A., Zubkoff M. Professional uncertainty and the problem of supplier-induced demand. Soc Sci Med. 1982;16(7):811–824. doi: 10.1016/0277-9536(82)90234-9. [DOI] [PubMed] [Google Scholar]
  15. Wennberg J. E., Gittelsohn A. Health care delivery in Maine I: patterns of use of common surgical procedures. J Maine Med Assoc. 1975 May;66(5):123-30, 149. [PubMed] [Google Scholar]

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