Background
There is a growing interest in the quality and cost of care provided
at Critical Access Hospitals (CAH), a predominant source of care for many
rural populations in the United States.
Objectives
To evaluate utilization, outcomes, and costs of inpatient surgery
performed at CAH.
Design, Setting, and Patients
We used data from the Nationwide Inpatient Sample (NIS) and American
Hospital Association (AHA) to perform a retrospective cohort study of
patients undergoing inpatient surgery from 2005 through 2009 at CAH or
non-CAH.
Main Outcome Measures
In-hospital mortality, prolonged length-of-stay, and total hospital
costs.
Results
Among the 1,283 CAH and 3,612 non-CAH reporting to the AHA,
35% and 36%, respectively, had at least one year of data in
the NIS. General surgical, gynecologic, and orthopedic procedures comprised
96% of inpatient cases at CAH versus 78% at non-CAH
(p<0.01). For 8 common procedures examined (appendectomy,
cholecystectomy, colorectal cancer resection, Caesarean section,
hysterectomy, knee replacement, hip replacement, hip fracture repair),
mortality was equivalent between CAH and non-CAH (p>0.05 for all),
with the exception that Medicare beneficiaries undergoing hip fracture
repair in CAH had a higher risk for in-hospital death (Adjusted odds ratio
1.37, 95% CI: 1.01 – 1.87). However, despite shorter
hospital stays (p<0.01 for 4 procedures), costs at CAH were
10–30% higher (p<0.01 for all 8 procedures).
Conclusions
In-hospital mortality for common low-risk procedures is
indistinguishable between CAH and non-CAH. Although our findings suggest the
potential for cost savings, changes in payment policy for CAH could diminish
access to essential surgical care for rural populations.