Trends in Surgical Quality at Critical Access Hospitals

Area of Science:

• Healthcare quality research
• Surgical outcomes analysis
• Rural health disparities

Background:

• Critical Access Hospitals (CAHs) face dual challenges of maintaining access and ensuring quality of care.
• While medical condition quality trends are documented, surgical care quality in CAHs requires further understanding.

Purpose of the Study:

• To longitudinally compare the trends in quality of surgical care for common procedures at CAHs versus non-CAHs.
• To assess the safety and efficacy of surgical services provided by rural hospitals.

Main Methods:

• Retrospective longitudinal cohort study of Medicare beneficiaries from 2010-2020.
• Analysis included common surgical procedures: appendectomy, cholecystectomy, colectomy, and hernia repair.
• Risk-adjusted multivariable logistic regression accounted for patient and hospital characteristics.

Main Results:

• 3,404,911 admissions at 890 CAHs and 3,687 non-CAHs were analyzed.
• Mortality rates improved similarly in both CAHs (6.9% to 4.7%) and non-CAHs (7.3% to 5.3%) with no significant difference in improvement rates.
• Serious complication rates also improved at CAHs (8.7% to 7.1%) and non-CAHs (18.8% to 13.4%).

Conclusions:

• Surgical quality improvements at CAHs have paralleled those at non-CAHs over the past decade.
• This study provides longitudinal evidence supporting the safety of surgical care in rural facilities.
• Findings can inform evidence-based policy decisions for preserving rural healthcare access and quality.