Concept: Discretionary, Non-discretionary and Intermediate Procedures

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.

SAS Formats and Labels

See vaydaf.html