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Emergency General Surgery Outcomes for Rural Patients: A Comparative Analysis of Rural, Micropolitan, and

Anthony J Duncan1, Samuel J Bloomsburg1, Wade Hopper1

  • 1University of North Dakota, School of Medicine & Health Sciences, Department of Surgery, Fargo, ND, USA.

The American Surgeon
|September 17, 2025
PubMed
Summary

Rural emergency surgery patients transferred to metropolitan centers have similar outcomes, but micropolitan patients face higher mortality due to increased acuity. Centralized transfer systems may improve equity in emergency general surgery care.

Keywords:
acute care surgerygeneral surgeryother

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Area of Science:

  • Surgery
  • Public Health
  • Health Services Research

Background:

  • Limited healthcare access in rural areas due to physician shortages creates disparities in emergency general surgery.
  • Timely intervention is crucial for emergency general surgery patients, particularly those in underserved regions.
  • This study investigates the impact of patient origin (rural vs. metropolitan) on emergency general surgery outcomes.

Purpose of the Study:

  • To evaluate the effect of rurality on outcomes for emergency general surgery patients transferred to a metropolitan center.
  • To compare outcomes across different degrees of rurality (metropolitan, micropolitan, small town, rural).

Main Methods:

  • Retrospective single-center cohort study of 1189 patients undergoing emergent exploratory laparotomies.
  • Patient rurality categorized using Rural-Urban Commuting Area (RUCA) codes.
  • Primary outcome measured was in-hospital mortality.

Main Results:

  • Rural and small-town patients showed similar preoperative comorbidities, acuity scores, surgical interventions, and outcomes compared to metropolitan patients.
  • Micropolitan patients presented with higher acuity (PESAS scores) and underwent more damage control laparotomies.
  • Micropolitan patients experienced higher mortality rates (23%) compared to metropolitan (13-15%) and rural/small-town groups.

Conclusions:

  • A well-established transfer system can promote equitable outcomes for emergency general surgery patients regardless of their origin.
  • Micropolitan patients appear to be sicker upon transfer, suggesting lower-acuity cases may be managed locally.
  • Further research into pre-transfer care and patient selection for transfer is warranted.