The Impact of New Surgical Techniques on Geographical Unwarranted Variation: The Case of Benign Hysterectomy

Abstract

Since the 1980s, the international literature has reported variations for healthcare services, especially for elective ones. Variations are positive if they reflect patient preferences, while if they do not, they are unwarranted, and thus avoidable. Benign hysterectomy is among the most frequent elective surgical procedures in developed countries, and, in recent years, it has been increasingly delivered through minimally invasive surgical techniques, namely laparoscopic or robotic. The question therefore arises over what the impact of these new surgical techniques on avoidable variation is. In this study we analyze the extent of unwarranted geographical variation of treatment rates and of the adoption of minimally invasive procedures for benign hysterectomy in an Italian regional healthcare system. We assess the impact of the surgical approach on the provision of benign hysterectomy, in terms of efficiency (by measuring the average length of stay) and efficacy (by measuring the post-operative complications). Geographical variation was observed among regional health districts for treatment rates and waiting times. At a provider level, we found differences for the minimally invasive approach. We found a positive and significant association between rates and the percentage of minimally invasive procedures. Providers that frequently adopt minimally invasive procedures have shorter average length of stay, and when they also perform open hysterectomies, fewer complications.

Driving time drives the hospital choice: choice models for pelvic organ prolapse surgery in Italy

“…Since POP surgery is a type of elective surgery prone to practice variation and large differences in treatment rates among Tuscan health districts have already been documented [ 28 , 35 ], this article can partly contribute to understanding the determinants of such variation. Indeed, practice variation is a major topic in elective surgery, as being related to the equity of access to health services, which is one of the threefold missions of healthcare systems pursuing universal coverage [ 36 , 37 ]. As variation should be driven just by patients’ preferences, unwarranted variation—not justified by real differences in patients’ needs—should be reduced [ 38 , 39 ].…”

Regional practice variation in pelvic organ prolapse surgery in Tuscany, Italy: a retrospective cohort study on administrative health data

“…18 This is valid also for elective gynaecological surgery, with high variation in treatment rates observed for benign hysterectomy. 19 Like hysterectomy, POP surgery is a variation-prone kind of surgery, with potential risks of inappropriate under-treatment/ over-treatment. 20 Several studies on practice variation are available.…”

Higher readability of institutional websites drives the correct fruition of the abortion pathway: A cross-sectional study

“…However, the quality of health administrative databases of Tuscany is routinely checked by the Regional Health Information System Office, making such data reliable. Indeed, previous studies employing such data to explore practice variation have been published [39]. So, these data are well-validated, easily accessible, and allow gathering real-world information about the entire population of interest [40].…”