The impact of new surgical techniques on geographical unwarranted variation: The case of benign hysterectomy

Since the 1980s, the international literature has reported variations for healthcare services,especially for elective ones. Variations are positive if they reflect patient preferences, while ifthey do not, they are unwarranted, and thus avoidable. Benign hysterectomy is among the mostfrequent elective surgical procedures in developed countries, and, in recent years, it has beenincreasingly delivered through minimally invasive surgical techniques, namely laparoscopic orrobotic. The question therefore arises over what the impact of these new surgical techniques onavoidable variation is. In this study we analyze the extent of unwarranted geographical variation oftreatment rates and of the adoption of minimally invasive procedures for benign hysterectomy in anItalian regional healthcare system. We assess the impact of the surgical approach on the provision ofbenign hysterectomy, in terms of efficiency (by measuring the average length of stay) and efficacy (bymeasuring the post-operative complications). Geographical variation was observed among regionalhealth districts for treatment rates and waiting times. At a provider level, we found differences forthe minimally invasive approach. We found a positive and significant association between rates andthe percentage of minimally invasive procedures. Providers that frequently adopt minimally invasiveprocedures have shorter average length of stay, and when they also perform open hysterectomies,fewer complications.