REGIONAL VARIATION IN GENERAL SURGERY VOLUME AND ITS ASSOCIATION WITH HEALTHCARE SYSTEM CAPACITY: A NATIONAL STUDY FROM SAUDI ARABIA

Abstract

Background: Access to surgical care is a critical component of health system performance; however, disparities in surgical service delivery persist across regions. Such variation may be more closely related to differences in healthcare system capacity than to actual population need.

Objective: To analyze regional disparities in general surgery volume across Saudi Arabia and examine their association with healthcare system capacity indicators.

Methods: This national cross-sectional ecological study used publicly available data from the Saudi Open Data Platform and the Ministry of Health Statistical Yearbook (2024). General surgery volume was analyzed across 13 administrative regions and expressed per 100,000 population. Healthcare system capacity indicators included hospital density, hospital bed density, and primary healthcare center density. Pearson correlation and univariable linear regression analyses were performed.

Results: Substantial regional variation in general surgery volume was observed, ranging from 252.9 to 1,056.7 procedures per 100,000 population. Surgical volume was positively associated with hospital density (r = 0.603, p = 0.029), hospital bed density (r = 0.590, p = 0.034), and primary healthcare center density (r = 0.657, p = 0.015). Healthcare system capacity indicators explained approximately 34%–43% of the variation in surgical activity.

Conclusion: Regional differences in general surgery volume are closely associated with healthcare system capacity. Surgical service distribution may reflect where capacity exists, rather than where need is greatest. These findings highlight the importance of equitable, data-driven health system planning and underscore the need to move beyond infrastructure expansion toward capacity-aligned, need-informed strategies to ensure equitable surgical care delivery across regions.