A patient’s odds of undergoing surgery often depends more on where he or she lives than on their clinical circumstances, according to a two-part series exploring variation in surgery use, published in The Lancet.

In the first part of the series, University of Michigan surgeon John Birkmeyer and colleagues suggest regional variation in the use of surgical procedures exists in many different countries, yet patient demand and differences in diagnostic practices do not appear to have much of an effect on these differences. Instead, Birkmeyer cautions that the motivations and beliefs of doctors are the most important reasons for surgical variation.

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