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Critical Access Hospitals As Good, Or Better, for Common Surgical Procedures

ANN ARBOR, MI – Bigger isn’t always better, according to a new study which finds that critical access hospitals aren’t always just waystations to higher-quality care in larger institutions.

In fact, a study published in the Journal of the American Medical Association finds that rural hospitals can be safer and less expensive for some common surgical procedures.

The small-town facilities are the closest acute care option for millions of Americans living in rural areas. University of Michigan-led researchers found that, in many cases, relatively healthy patients might do better having surgery close to home than traveling to a hospital in a metropolitan area.

For the study, data was analyzed from 1.6 million hospital stays for four common procedures — gallbladder removal, colon surgery, hernia repair and appendectomy — with Medicare patients having surgery at 828 critical access hospitals compared to those treated at more than 3,600 larger hospitals.

Results indicate that the risk of dying within 30 days was the same whether a patient had surgery at a critical access hospital or a larger hospital, while the risk of suffering a major complication after surgery, such as a heart attack, pneumonia or kidney damage, actually was lower at critical access hospitals.

In terms of expense, patients treated at a critical access hospital cost the Medicare system nearly $1,400 less than patients who had surgery at a larger hospital, after differences in patient risk were considered.

The study also suggests that surgeons at critical access hospitals are appropriately selecting healthier patients who are likely to do well in a small rural setting, while triaging more complex patients to larger centers.

Even after the researchers corrected for differences in preoperative health, the critical access hospitals posted equal or better outcomes.

Background information in the article points out that hundreds of critical access hospitals are in danger of closing, despite current Medicare policy to pay more than the actual cost of care to help them stay financially viable.

"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," explained lead author Andrew Ibrahim, MD, of the University of Michigan.

"The goal of the rural surgeon is best care nearest home,” added co-author Tyler Hughes, MD, of the critical access McPherson (KS) Hospital. “Data to assure that the care in rural centers is both safe and cost effective is critical in the decisions the profession faces in providing care to the 20% of the U.S. population living in truly rural environments. This study gives credence to what rural surgeons long suspected: that well-done rural surgery is safe and cost effective."