Association for Academic Surgery (AAS)

Inspiring and Developing Young Academic Surgeons

Using Geographic Information Systems in Surgical Research

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Geography is a critical component of surgical care delivery that affects access to care, burdens of treatment, and spatially-related determinants of health such as environmental risk factors for disease. Its widespread applicability and importance has led to a rise in popularity of geographic information systems (GIS) as a tool for surgical research. GIS is technology with spatial data processing, analysis, and sharing abilities used to create, manage, analyze, and map data.1 By combining, or “stacking,” spatially-related data such as geographic boundaries, area-specific disease incidence information, and area-level socioeconomic characteristics, a GIS scientist can understand relationships between geography, disease, and its management. GIS has been employed by investigators to evaluate wide array of salient surgical topics. Some examples include examining county level differences in liver-related mortality access to liver transplant2 and studying the relationship between housing discrimination and racial cancer disparities.3 As we now approach the 25th anniversary of annual GIS Day this November 20th, we reached out to Ariann Nassel, the Director of Geospatial Data Visualization at the University of Alabama at Birmingham, to ask her about the role of GIS in surgical research and how those interested in learning more can get started.

Do you have any advice for those just beginning to learn about GIS and interested in applying it to their research?

“My advice is coming from a person who’s teaching people like you all… It’s not so much about learning the technology, [but about] understanding the data you’ve put in and the output that you’ve gotten… I tell people, even if I give you a data set, go through the data set, understand the data set, and don’t trust the data set until you’ve looked at it.”

How do you think surgeons can use GIS in their research or practice?

“People are using it for looking at the social determinants of health in the areas that people live and how that is going to affect their recovery and their overall health outcome. Let’s say it’s a heart transplant, and the person lives in a really disadvantaged area. Does that impact their outcome? What if they actually make good money and they live in a historically disadvantaged area? Does that affect the outcome?”
“What’s incredible is that [surgeons] are doing [GIS] because I’m limited in my understanding of what kind of data you have and what kind of questions are going to be of interest, because I’m not a surgeon. So once you guys learn a little more about what you can do with it, all kinds of questions will come to mind for you that people like me would never have thought to ask or would have been knowledgeable of… only you know your subject matter best and what is going to be valuable for you to study or look at.”

What limitations or challenges do you see people encounter most often when using GIS for research? And what learning points do you see people take away?

“I don’t see the limitation in the technology, it’s in the data…For example, people are using [GIS] for just getting their data geocoded and adding the FIPS codes… It’s really easy to do, but if you don’t understand the settings and you don’t, for example, understand that a PO Box doesn’t represent where a person lives, and you also don’t understand that you’re probably losing a fair number of rural addresses because they don’t geocode well …[it can make your analysis difficult]. It’s something to consider if you’re doing rural research or comparing rural to urban, you should ideally look at your data set and see what didn’t code. Do they look like they might be rural addresses, and can you go in and maybe dig out from another source that address?”

“Then the issue, especially for surgeons, is patient level data has to be treated very differently [because of] the issue of privacy… How can you utilize that data and get the granular level of analysis that is beneficial for health research while maintaining health privacy? You can absolutely use patient level data, but then when you go to present that or publish that, you need to make accommodations and have consideration for how you represent that data.”

As Michael F. Goodchild, a pioneer in GIS, stated “Almost everything that happens, happens somewhere. Knowing where something happens can be critically important.”4 That critical importance remains true in surgical research. For those interested in incorporating GIS as part of their research methodology, there are several programs available. Many academic institutions offer GIS software for free to students, staff, and faculty. There are other free or affordable options available. QGIS5 is an example of a free, open-source program downloadable from their webpage, and ESRI offers a discounted student package, aptly named “ArcGIS for Student Use”6 which is the same as the software offered for commercial use. There are free statistical software programs, such as R,7 that offer data analysis and mapping tools as well.

We have observed increased enthusiasm for using geospatial analysis in surgical research and anticipate expanding opportunities for GIS in surgical research.

1. Kurland KS. GIS Jump Start for Health Professionals. Esri Press; 2021.
2. Cannon RM, Nassel A, Walker JT, et al. County-level Differences in Liver-related Mortality, Waitlisting, and Liver Transplantation in the United States. Transplantation. 2022;106(9):1799. doi:10.1097/TP.0000000000004171
3. Beyer KMM, Laud PW, Zhou Y, Nattinger AB. Housing discrimination and racial cancer disparities among the 100 largest US metropolitan areas. Cancer. 2019;125(21):3818-3827. doi:10.1002/cncr.32358
4. Longley PA, Goodchild MF, Maguire DJ, Rhind DW. Geographic Information Science and Systems. John Wiley & Sons; 2015.
5. QGIS Development Team. QGIS Geographic Information System. https://www.qgis.org
6. ArcGIS for Student Use | GIS Software, Data & Training for Students. Accessed October 30, 2024. https://www.esri.com/en-us/arcgis/products/arcgis-for-student-use/overview
7. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/

 

 

 

 

Nicole Rademacher, MD

Nicole Rademacher, MD

Nicole Rademacher, MD is a general surgery resident at the University of Alabama at Birmingham and current post-doctoral fellow supported by the AHRQ T32 program. She is a graduate of the Medical College of Wisconsin where she earned her Medical Degree. She is interested in health services research and understanding the factors that drive quality of cancer care.
Nicole Rademacher, MD

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Kristy Broman, MD, MPH

Kristy Broman, MD, MPH

Kristy Broman, MD, MPH is an Assistant Professor in the UAB Division of Surgical Oncology with a clinical practice in skin and soft tissue surgical oncology. She is a graduate of Vanderbilt University School of Medicine in Nashville, Tennessee, where she earned her Medical Degree and Master of Public Health Degree. She then completed residency in General Surgery at Vanderbilt University Medical Center, which included a three-year research fellowship in the Veterans Affairs National Quality Scholar Program, a national training program in conduct of health services research, quality improvement and implementation science. She completed her two-year clinical fellowship training in Surgical Oncology at Moffitt Cancer Center in Tampa, Florida. She is faculty member of the UAB Institute for Cancer Outcomes and Survivorship where she conducts health services and outcomes research, emphasizing implementation strategies for delivery of high-quality care across the cancer care continuum.
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About Nicole Rademacher, MD

Nicole Rademacher, MD is a general surgery resident at the University of Alabama at Birmingham and current post-doctoral fellow supported by the AHRQ T32 program. She is a graduate of the Medical College of Wisconsin where she earned her Medical Degree. She is interested in health services research and understanding the factors that drive quality of cancer care.