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Navigating Limited Resources-Outpatient Pediatric Cholecystectomies at Rural Hospitals.

Erin C Howell¹, Rie Sakai-Bizmark², Shannon Richardson³

¹Department of Surgery, University of New Mexico School of Medicine, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA; Department of Surgery, Harbor-UCLA Medical Center, 1000 W. Carson Street, Box 42, Torrance, CA 90502, USA.

Journal of Pediatric Surgery

|January 21, 2025

Summary

Pediatric cholecystectomy at rural hospitals is safe and leads to better routine discharge rates, even with patients having lower incomes and more comorbidities. These findings highlight the effectiveness of rural surgical care.

Keywords:

Elective Laparoscopic cholecystectomy Pediatric surgery Rural

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Area of Science:

Pediatric Surgery
Health Services Research
Rural Health

Background:

Rural hospitals are vital for pediatric surgical services.
Outpatient pediatric cholecystectomy outcomes at rural vs. urban hospitals were analyzed.
The study hypothesized similar outcomes between rural and urban settings.

Purpose of the Study:

To compare outpatient pediatric cholecystectomy outcomes between rural and urban hospitals.
To assess the safety and effectiveness of rural pediatric surgical care.
To identify disparities in patient populations and outcomes.

Main Methods:

Retrospective cohort analysis of 15,449 pediatric cholecystectomies (2016-2018) from the Nationwide Ambulatory Surgery Sample (NASS).
Survey-weighted multivariate regression analyses evaluated the association of hospital location (rural vs. urban) with routine discharge.
Models adjusted for patient demographics, comorbidities, insurance, income, and surgical indications.

Main Results:

Rural patients had lower median incomes and more complex comorbidities than urban patients.
Laparoscopic cholecystectomy was standard (>99%) with rare complications and no deaths in both settings.
Rural hospital patients had a higher odds ratio for routine discharge (adjusted OR 2.27, p=0.04).

Conclusions:

Pediatric patients at rural hospitals face socioeconomic and health challenges.
Outpatient cholecystectomy is safe in rural settings.
Rural hospitals demonstrated improved odds of routine discharge for pediatric cholecystectomy compared to urban facilities.