Utilization rates for surgical procedures in rural and urban Canada.
OBJECTIVE
To investigate whether utilization rates of common surgical procedures are different between urban and rural Canadians in 2 provinces and to examine whether these rates are influenced by the presence and scope of local surgical programs and by the availability of different physician providers.


METHODS
Utilization rates for 8 common surgical procedures (appendectomy, carpal tunnel release, closed hip fracture repair, rectal cancer surgery, joint replacement, thyroidectomy, unilateral or bilateral inguinal herniorrhaphy, and cholecystectomy) were identified in rural Alberta and rural Northern Ontario from hospital discharge records. Rural populations were characterized by 3 types of communities, based on availability of local physician and diagnostic resources. Travel time for consultations and surgery were estimated. Age-sex-adjusted rates, their standard errors, and 95% confidence intervals (CIs) were calculated for the purpose of comparisons among residents' locations using the method of direct standardization. To test a possible association between travel times and utilization rates, hierarchical linear and nonlinear modelling was used to analyze a 2-level model, with patients nested within rural hospital catchment areas in the province of Alberta.


RESULTS
Utilization rates for appendectomy, cholecystectomy and carpal tunnel release are significantly greater for rural populations compared with urban in both Alberta and Northern Ontario. Rural Northern Ontario had higher rates of utilization than rural Alberta for carpal tunnel release and cholecystectomy (p < 0.01) and closed hip fracture repair (p < 0.05). No statistical differences between the provinces were noted for the remaining procedures. No difference in utilization rates was found between the 3 types of rural centres. The modelling found a significant association between travel time and use for only one procedure--carpal tunnel release. Patients who had to travel < or =1 hour had a 13% higher surgery rate.


CONCLUSIONS
Rates of utilization were higher in rural areas for procedures where greater surgical variability is known to exist. These higher rural rates were not influenced by either the presence or scope of local surgical programs nor by the differences in providers. There was no difference in rates for procedures where previous research has shown little variability.
Tepper
Joshua
J
Institute of Clinical Evaluative Sciences, Toronto, ON M4N 3M5.
Pollett
William
W
Jin
Yan
Y
Ellehoj
Erik
E
Hutten-Czapski
Peter
P
Schopflocher
Don
D
Barrett
Brendan
B
Iglesias
Stuart
S
D000416:Alberta; D001062:Appendectomy / Q000706:statistics & numerical data; D002349:Carpal Tunnel Syndrome / Q000601:surgery; D002391:Catchment Area, Health; D002763:Cholecystectomy / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006620:Hip Fractures / Q000601:surgery; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D009864:Ontario; D012424:Rural Population; D013514:Surgical Procedures, Operative / Q000145:classification / Q000706:statistics & numerical data*; D013965:Thyroidectomy / Q000706:statistics & numerical data; D013995:Time; D014195:Travel; D014505:Urban Population