Surgery surprise: Small rural hospitals may be safer, less expensive for common operations

http://www.eurekalert.org/pub_releases/2016-05/uomh-sss051216.php

Public Release: 17-May-2016
Surgery surprise: Small rural hospitals may be safer, less expensive for common operations
Critical access hospital study suggests local care works well for straightforward surgical cases in uncomplicated patients
University of Michigan Health System

They may be in small towns. They may only have a couple of surgeons. But for common operations, they may be safer and less expensive than their larger cousins, a new study finds.

"They" are critical access hospitals - a special class of hospital that's the closest option for tens of millions of Americans living in rural areas. And according to new findings published in the Journal of the American Medical Association, having surgery at one of them may be a better bet for most relatively healthy patients than traveling to a suburban or city hospital.

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The analysis yielded several surprises:

The risk of dying within 30 days of the operation was the same whether a patient had surgery at a critical access hospital or a larger hospital.
The risk of suffering a major complication after surgery, such as a heart attack, pneumonia or kidney damage, was lower at critical access hospitals.
Patients who had their operation at a critical access hospital cost the Medicare system nearly $1,400 less than patients who had the same operation at a larger hospital, after differences in patient risk and pricing were accounted for.
The patients who had these operations at critical access hospitals were healthier to begin with than patients treated elsewhere, suggesting that critical access hospital surgeons are appropriately selecting surgical patients who can do well in a small rural setting, and triaging more complex patients to larger centers.
But even after the researchers corrected for differences in pre-operation health, the critical access hospitals still had equal or better outcomes.

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Hundreds are these hospitals are in danger of closing, threatening local access to care for millions of Americans.

Currently, the Medicare system essentially subsidizes them by paying them slightly more than the total cost of care, in order to ensure they can stay financially afloat to serve rural areas. Even still, dozens have closed in recent years.

Recent studies of common medical conditions like heart attacks and pneumonia at critical access hospitals have raised questions about how well they care for patients with these conditions. The new study is the first comprehensive look at the surgical care they provide.

"From a surgical standpoint, these hospitals appear to be doing exactly what we would want them to be doing: common operations on appropriately selected patients who are safe to stay locally for their care," says Andrew Ibrahim, M.D., first author of the new study and a VA/Robert Wood Johnson Clinical Scholar at the U-M Medical School.

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Other findings from the study:

Less than 5 percent of surgery patients at critical access hospitals got transferred to larger hospitals, compared with more than a quarter of patients treated for non-surgical issues and studied by other teams.
Critical access hospital surgery patients were less likely to use skilled nursing facilities after their operations.
Complex operations such as esophagus or pancreas removal were performed so rarely at critical access hospitals they were not included in the study.

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