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Regional Variation in Surgery for Gastroesophageal Reflux Disease in Ontario

Department of Surgery, University of Toronto, Ontario, Canada, Institute for Clinical Evaluative Sciences, Toronto, Department of Health Policy, Management and Evaluation, University of Toronto

Peter C. Austin, PhD

Institute for Clinical Evaluative Sciences, Toronto, Department of Health Policy, Management and Evaluation, University of Toronto, Department of Health Policy, Management and Evaluation, University of Toronto

Linda Rabeneck, MD, MPH

Institute for Clinical Evaluative Sciences, Toronto

Girish S. Kulkarni, MD

Department of Surgery, University of Toronto, Ontario, Canada, Institute for Clinical Evaluative Sciences, Toronto, Department of Health Policy, Management and Evaluation, University of Toronto, Department of Health Policy, Management and Evaluation, University of Toronto

David R. Urbach, MD, MSc

Department of Surgery, University of Toronto, Ontario, Canada, David.Urbach{at}uhn.on.ca, Institute for Clinical Evaluative Sciences, Toronto, Department of Health Policy, Management and Evaluation, University of Toronto, Division of Clinical Decision Making and Health Care, University Health Network, Toronto, Department of Health Policy, Management and Evaluation, University of Toronto

The optimal treatment for gastroesophageal reflux disease (GERD) is unclear, and the degree of variation in the rate of antireflux surgery in different regions is unknown. Large variation has significant implications for health care spending and may represent uncertainty among health care providers. The objective of this study was to identify population-based utilization and measure area rate variations in the use of GERD surgery; 11 685 primary antireflux procedures in the provincial administrative health databases were studied. Small-area variation was quantified using 4 measures. The crude rate of antireflux procedures was 11.6/100 000 adults. Patients between the ages of 45 and 64 had the highest rates of surgery. More women than men underwent antireflux surgery (13.6 vs. 9.4 per 100 000). Between counties, adjusted surgical rates ranged from 5.0 to 28.7 per 100 000 persons. Significant regional variation exists for antireflux surgery across Ontario, suggesting that its appropriate role in the management of GERD remains ill-defined.

Key Words: gastroesophageal reflux disease (GERD) • small-area variation • antireflux surgery • fundoplication • health services research

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