A Comparison of Surgical Rates in Canada and in England and Wales

Abstract Comparison showed that surgical rates in Canada (1968) were 1.8 times greater for men and 1.6 times greater for women than in England and Wales (1967). The age-standardized and sex-specific rates for diverse elective and discretionary operations — such as tonsillectomy and adenoidectomy, hemorrhoidectomy and inguinal herniorrhaphy —were two or more times higher in Canada than in England and Wales. In elderly people, mortality from diseases of the gallbladder was twice as high in Canada as in England and Wales, but the Canadian cholecystectomy rate was more than five times greater. Because the compared rates for individual surgical procedures are suitably standardized, some of the disparities between the two countries are probably due to sources other than the incidence and prevalence of disease. Among the contributing factors are divergent styles of treatment and indications for surgery, but the main determinants may be the differences in organization and payment of health services, in functional "limited licensure" and in the numbers of surgeons and hospital beds. (N Engl J Med 289:1224–1229, 1973)