Concept: Discretionary, Non-discretionary and Intermediate Procedures
Concept Description
Last Updated: 2001-02-20
Introduction
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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References
- 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)
Keywords
- hospitalization
- surgery
- surgical rates