Max Rady College of Medicine

Concept: Discretionary, Non-discretionary and Intermediate Procedures

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Concept Description

Last Updated: 2001-02-20


    Based on variation in surgical rates across different regions in Canada, 39 ICD-9-CM procedures were classified into one of three categories according to the degree of discretion (Gentleman et al., 1996:362) .

    • "Primarily discretionary" - "those that may not be necessary at all, those for which there is not general agreement about indications (e.g., hysterectomy for non-malignant conditions of the uterus) and those for which alternative, non-surgical treatment options are available (e.g. varicose vein ligation and stripping)".

    • "Primarily non-discretionary" - "less controversial, and such an operation is generally the only treatment or a treatment of choice (e.g., colectomy for colon cancer, severe colitis or polyposis and thyroidectomy for hyperthyroid goitre)".

    • "Intermediate" - an intermediate degree of discretion.

    NOTE: There are actually 37 groupings here - Gentleman et al. had overlapping categories - i.e. colectomy was analyzed separately but it was also included in bowel surgery. Mastectomy also had overlapping categories.

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  • Gentleman JF, Vayda E, Parsons GF, Walsh MN. Surgical rates in sub-provincial areas across Canada - rankings of 39 procedures in order of variation. Can J Surg 1996;39(5):361-367. [Abstract] (View)
  • Roos NP. Hospitalization style of physicians in Manitoba: the disturbing lack of logic in medical practice. Health Serv Res 1992;27(3):361-384. [Abstract] (View)


  • hospitalization
  • surgery
  • surgical rates

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Manitoba Centre for Health Policy
Community Health Sciences, Max Rady College of Medicine,
Rady Faculty of Health Sciences,
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University of Manitoba
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