Regional variation in surgery for gastroesophageal reflux disease in Ontario

The optimal treatment for gastroesophageal reflux disease (GERD) is unclear, and the degree of variation in the rate of anti-reflux surgery in different regions is unknown.  Large variation has significant implications for health care spending and may represent uncertainty among health care providers.  The objective of this study was to identify population-based utilization and measure area rate variations in the use of GERD surgery.

Investigators studied 11,685 primary anti-reflux procedures in the provincial administrative health databases.  Small-area variation was quantified using four measures.  The crude rate of anti-reflux procedures was 11.6/100 000 adults.  Patients between the ages of 45 and 64 had the highest rates of surgery.  More women than men underwent anti-reflux surgery (13.6 vs. 9.4 per 100,000).  Between counties, adjusted surgical rates ranged from 5.0 to 28.7 per 100,000 persons.

Significant regional variation exists for anti-reflux surgery across Ontario, suggesting that its appropriate role in the management of GERD remains ill-defined.