Key messages
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Studies from many different countries show that the use of surgical procedures varies across regions
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Chance, patient demand, and differences in diagnostic practices have a small role in explanation of regional variation in surgical rates
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Different attitudes and beliefs about the indications for surgery are the most important reasons for surgical variation
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Discretionary, preference-sensitive procedures, such as radical prostatectomy, tend to vary considerably more than do procedures for which clinical decisions are constrained to a narrow range of options—eg, colectomy for colon cancer
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Tools to better incorporate the preferences of individual patients, such as decision aids, might help to reduce variation for preference-sensitive procedures
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Broad factors that affect regional variation include technology diffusion, training, the regional supply of surgeons, and financial incentives and the regulatory environment