Variation in the Care of Surgical Conditions

Twenty-first century surgery is among the great accomplishments of medicine. Surgeons have led some of the most important improvements in care quality, safety, and efficiency. Surgical methods are now highly effective for some of the most serious and previously intractable medical conditions, ranging from arthrosclerosis to obesity to chronic back pain. Today, surgical procedures work better and entail lower risk, less pain, and less time in the hospital.

However, as the scope and quality of surgical care continues to advance, there is still much that remains to be done to optimize care for patients. For many conditions, surgery is one of several care options, and in some instances, there are several types of surgical procedures available. Research into the effectiveness and adverse effects of a surgical procedure compared to alternatives is often incomplete. While quality has generally improved over time, outcomes can differ across hospitals and surgeons. Too often, treatment options, whether medical or surgical, are recommended without patients fully understanding the choices and participating in the decision; and these recommendations can vary markedly from one physician to the next. Finally, the costs of care continue to rise and often differ across health care systems, even the most reputable and prestigious. Why can the “best” surgical care at one academic medical center cost twice as much as another?

The bottom line is that the greatest promise of surgery still lies before us. These indicators and the reports that accompany them show that quality is often excellent, but not in all places. Variation in surgical rates is high and represents both gaps in outcomes research and poor patient decision quality. Outcomes differ from place to place even when controlling for patient differences. The opportunities for better and more efficient care are substantial and will require renewed efforts in research and clinical quality improvement.


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The Dartmouth Atlas of Health Care is based at The Dartmouth Institute for Health Policy and Clinical Practice and is supported by a coalition of funders led by the Robert Wood Johnson Foundation, including the WellPoint Foundation, the United Health Foundation, the California HealthCare Foundation, and the Charles H. Hood Foundation.