Bypass of Local Surgical Care in North Carolina: Patient-Directed Care Destination and Utilization

Area of Science:

• Health Services Research
• Surgical Care Access
• Rural Health Disparities

Background:

• Patient bypass of local surgical care is frequent but understudied.
• Previous research has not examined the link between bypass and local surgeon workforce density.

Purpose of the Study:

• To investigate the association between patient bypass of local surgical care and general surgeon workforce density.
• To identify factors associated with bypassing local surgical services for urgent/emergent procedures.

Main Methods:

• Retrospective cohort study of North Carolina patients undergoing urgent/emergent surgery (2016-2019).
• Defined bypass as receiving care at a hospital ≥ 10 miles farther from the nearest surgery-capable hospital.
• Used logistic regression to analyze associations with clinical, sociodemographic, and hospital characteristics.

Main Results:

• 23.7% of patients (n=9864) bypassed local surgical care, traveling significantly farther (median 25.8 vs 7.4 miles).
• Patients in counties with the lowest (aOR: 1.58) and second lowest (aOR: 1.55) general surgeon workforce density were more likely to bypass.
• Lower surgeon density was significantly associated with increased patient bypass.

Conclusions:

• Approximately 25% of patients bypass their nearest surgical hospital for urgent/emergent general surgery.
• Reduced local general surgeon workforce density is a significant factor contributing to patient bypass of nearest surgical care.
• Findings highlight potential access barriers in areas with lower surgeon availability.