Rural versus urban inpatient case-mix differences in the US

Area of Science:

• General Surgery
• Rural Health
• Health Services Research

Background:

• Surgical training for rural practice is limited by a lack of understanding of case-mix differences between rural and nonrural surgical practices.
• While rural surgical practice is presumed to differ from urban practice, actual inpatient case-mix variations are not well-documented.

Purpose of the Study:

• To compare inpatient general surgical procedures performed at rural versus urban hospitals in the US.
• To identify differences in the case mix of general surgical procedures between rural and urban hospital settings.

Main Methods:

• A retrospective analysis of inpatient general surgical procedures was conducted using the Nationwide Inpatient Sample database (2000-2001).
• Rural and urban geographic designations were determined using Rural-Urban Commuting Area codes.
• Surgical procedures were categorized using the Clinical Classifications Software based on ICD-9-CM codes.

Main Results:

• General surgical inpatient procedures in rural hospitals were dominated by bowel, appendix, and gallbladder operations (61%), compared to 46% in urban hospitals.
• Rural practices had fewer stomach, esophagus, liver, pancreas, spleen, thyroid, and bowel operations than urban practices.
• General surgical procedures comprised a larger proportion of all inpatient procedures in rural hospitals (42%) versus urban hospitals (25%).

Conclusions:

• Significant differences exist in the inpatient general surgical case mix between rural and urban hospitals.
• Enhanced training in specific areas like obstetrics, gynecology, vascular, head and neck, amputations, and nephrectomies could increase the scope of practice for rural general surgeons.