The new Dartmouth Atlas series on variation in the care of surgical conditions, starting with this report on the surgical treatment of obesity, raises new questions regarding surgical management of both common and less frequently occurring medical conditions. This report carefully details the scope of the ever-increasing problem of obesity and, as in previous Atlas analyses, emphasizes geographic practice variation in surgical treatment rates. However, the report also takes a more longitudinal view. The changes over time in which bariatric procedure is favored are particularly fascinating, driven as they appear to be by a mix of clinical evidence--including emerging long-term results--and reimbursement policy. Obese patients will often ask me, as a primary care physician, whether they should have one of these procedures, and, if so, where. These questions have always been hard to answer. Population-based registries, as described in the report, should go a long way toward producing the kind of widely applicable data upon which patient decision support tools should be based. Patients want to know procedure and facility-based risks and benefits.

The new Dartmouth Atlas series on variation in the care of surgical conditions, including this report on the treatment of diabetes and peripheral arterial disease, raises new questions regarding surgical management of both common and less frequently occurring medical conditions. This report carefully details the scope of the problem of diabetes and peripheral arterial disease and, as in previous Atlas analyses, emphasizes geographic practice variation in both preventive services and in surgical treatment rates. However, the report also takes a more patient-centered view. The goals of avoiding amputation and retaining the ability to walk are paramount. The best strategies to achieve these goals are the focus of quality improvement groups such as the Vascular Quality Initiative, described in this report. The outcomes data being recorded should go a long way toward producing the kind of widely applicable data upon which patient decision support tools should be based. Patients want to know procedure and facility-based risks and benefits.

The new Dartmouth Atlas series on variation in the care of surgical conditions, including this report on the procedures associated with end-stage renal disease, raises new questions regarding surgical management of both common and less frequently occurring medical conditions. This report carefully details the issues surrounding dialysis access surgery, access to transplantation and transplant related care, and the impact of transplantation on patient-related outcomes. As in previous Atlas analyses, the authors emphasize geographic practice variation in rates of dialysis access surgery and transplantation. However, the report also takes a broader view, describing the resources necessary to help patients make the best decisions for their complex care.

The new Dartmouth Atlas series on variation in the care of surgical conditions, including this report on the surgical treatment of back pain resulting from spinal stenosis, raises new questions regarding surgical management of both common and less frequently occurring medical conditions. This report carefully details the issues surrounding spinal stenosis, including the physical and economic burden, the difficulties of obtaining a definitive diagnosis, and patient decision-making, and, as in previous Atlas analyses, emphasizes geographic practice variation in surgical treatment rates. However, the report also takes a more longitudinal view. The changes over time in which procedure is favored to treat back pain and spinal stenosis are particularly fascinating, driven as they appear to be by a mix of clinical evidence--including emerging long-term results--and physicians' opinions and personal experience.

The new Dartmouth Atlas series on variation in the care of surgical conditions, including this report on the surgical treatment of cerebral aneurysms, raises new questions regarding surgical management of both common and less frequently occurring medical conditions. This report carefully details the prevalence of cerebral aneurysms and, as in previous Atlas analyses, emphasizes geographic practice variation in surgical treatment rates. However, the report also takes a more longitudinal view. The changes over time in which procedure is favored to treat aneurysms are particularly fascinating, driven as they appear to be by a mix of clinical evidence--including emerging long-term results--and physicians' opinions and personal experience.

Essential Surgery is part of a nine volume series for Disease Control Priorities which focuses on health interventions intended to reduce morbidity and mortality. The Essential Surgery volume focuses on four key aspects including global financial responsibility, emergency procedures, essential services organization and cost analysis.