Study says surgeries are safer and cheaper at critical-access hospitals, which are rural

It's safer and cheaper to have surgery at a rural hospital than an urban ones, says a study by University of Michigan researchers published in The Journal of the American Medical Association. Researchers found that critical-access hospitals, which by definition are rural, had significantly lower rates of serious complications—6.4 percent to 13.9 percent. Also, "Medicare expenditures adjusted for patient factors and procedure type were lower at critical-access hospitals than non–critical access hospitals," averaging $14.450 at critical access hospitals, compared to $15,845 at larger ones. (UM graphic)

The study examined 1,631,904 Medicare beneficiary admissions to 828 critical-access hospitals and 3,600 larger non–critical access hospitals for four surgical procedures—appendectomy, cholecystectomy, colectomy and hernia—from 2009 to 2013. Researchers "compared risk-adjusted outcomes using a multivariable logistical regression that adjusted for patient factors (age, sex, race, Elixhauser comorbidities), admission type (elective, urgent, emergency), and type of operation.

The risk of dying within 30 days of the operation "was the same across all hospitals," Susan Scutti reports for Medical Daily. But researchers "discovered the risk of suffering a major complication after surgery was lower at critical access hospitals compared to larger facilities. Complications included heart attacks, pneumonia, and kidney damage. Importantly, the researchers discovered patients who had these operations at critical access hospitals checked in healthier to begin with, suggesting that surgeons in these remote hospitals are appropriately selecting patients who will do well in a small rural setting while triaging more complex patients to larger centers."

"The study’s limitations include the possibility that the research team may have overestimated complication rates at larger hospitals due to how administrative reports code data," Scutti writes. "Still, the results indicate these hospitals perform well and safely at least from a surgical standpoint. Lead author Dr. Andrew Ibrahim and his co-researchers believe the implications of their work are significant to Medicare policies."