Study finds no real difference in outcomes of rural residents' colon-cancer surgeries at rural and urban hospitals

Colon-cancer patients who are concerned that their rural hospital won't be as good for surgery as an urban hospital can take some reassurance from a recent study of Medicare data that found no difference in the outcomes of colon-cancer surgery for rural residents at rural and non-rural hospitals.

"Given that colon cancer is the third most common cancer diagnosis in the United States and colon resection is considered an intermediate risk surgery, identifying whether it can be safely performed in rural settings is a priority for both health care providers and policymakers," the researchers write in The Journal of Rural Health. "Many patients who live in rural settings may prefer to have surgery performed locally if operative mortality is equivalent at rural and nonrural hospitals. In turn, data from the current study strongly suggest that safe and affordable care can be delivered at rural hospitals for patients in need of colectomy for colon cancer. . . . While complex surgical procedures are best performed at high-volume centers, some investigators have suggested that more common low-risk operations can be performed in rural communities with comparable outcomes as high-volume urban centers."

The study designated as "rural" counties that are in the top three categories of the Department of Agriculture's nine-step index of rurality. It looked for post-operative complications in 3,937 surgeries, ranging from infection to death within 30 days of the surgery. It found that the risk-adjusted probability of a post-operative complication was 16.3% at a rural hospital and 15.4% at a non-rural hospital. The risk of death was 3.5% in rural hospitals and 2.9% in non-rural hospitals. The differences are not statistically significant.