Gentleman J F, Vayda E, Parsons G F, Walsh M N
Health Statistics Division, Statistics Canada, Ottawa, Ont.
Can J Surg. 1996 Oct;39(5):361-7.
To rank 39 surgical procedures in order of variation of inpatient surgical rates, according to a new index of variation and to test the hypothesis that there is greater variation for primarily discretionary operations than for primarily non-discretionary operations.
A population-based retrospective cohort study.
Nine provinces (99.19% of Canada's population).
All hospital inpatients who underwent any of 39 types of surgery and were separated from hospital between Apr. 1, 1988 and Mar. 31, 1990 (the most recent time period for which Canada-wide data were available at the subprovincial level analysed).
Rankings of the 39 procedures according to the index of variation, calculated from inpatient surgery rates in 255 census divisions across Canada.
The 13 procedures with the greatest variation were all primarily discretionary. Thirteen of the 14 procedures with the lowest variation were primarily non-discretionary. All but one of the procedures whose degree of discretion was deemed intermediate were in the middle third of the rankings.
The greatest variation is found in primarily discretionary operations. Further investigation should be focused on identified geographical locations where rates for operations that are primarily discretionary are unusually high or low, and particularly on those operations for which there is disagreement regarding the indications for surgery.
根据一种新的变异指数，对39种外科手术按住院手术率的变异程度进行排序，并检验主要为可自由决定的手术比主要为非自由决定的手术变异更大这一假设。
基于人群的回顾性队列研究。
九个省份（占加拿大人口的99.19%）。
1988年4月1日至1990年3月31日期间（在省级以下层面分析可获得全加拿大数据的最近时间段）接受39种手术中的任何一种并出院的所有住院患者。
根据变异指数对39种手术进行排序，该指数由加拿大255个人口普查区的住院手术率计算得出。
变异最大的13种手术均主要为可自由决定的手术。变异最小的14种手术中有13种主要为非自由决定的手术。除一种手术外，所有被认为自由决定程度为中等的手术均排在中间三分之一。
主要为可自由决定的手术变异最大。进一步调查应聚焦于主要为可自由决定的手术率异常高或低的特定地理位置，尤其应关注那些在手术适应症方面存在分歧的手术。
