Outpatient surgical institutions in the rural United States: Trends from 2010 to 2020

The volume and proportion of surgeries occurring in outpatient settings has increased. However, the growth and distribution of outpatient surgical institutions, namely ambulatory surgery centers (ASCs) and hospital-based outpatient surgical departments (HOPDs), remains understudied in rural areas.

We used descriptive statistics and a multivariate logistic regression to assess the growth and distribution of ASCs and HOPDs in rural areas from 2010 to 2020, leveraging the Area Health Resources Files and American Community Survey.

From 2010 to 2020, the number of ASCs in rural counties decreased by 4.9 ​% (410 vs. 390), and rural HOPDs decreased by 14.3 ​% (1400 vs. 1200). Completely rural counties were over five times likelier to lack both ASCs and HOPDs (AOR ​= ​5.32; 95 ​% CI ​= ​[4.82-5.89]); p ​< ​0.001).

Outpatient surgical institution access in rural America declined. Policymakers should protect rural HOPDs, promote the creation of ASCs in rural communities, and incentivize surgeons to enter rural practice.