Clinical and system-level predictors of postacute care use among rural emergency general surgery patients

Postacute care services (PACS) are one of the fastest-growing programs funded by the Centers for Medicare and Medicaid (CMS), with potential promise to rural communities. Emergency general surgery (EGS) is essential to many hospitals. Yet little is known about post-EGS PACS utilization, especially among rural communities, which have longstanding barriers to healthcare access and greater travel distances. This study seeks to uncover drivers of PACS utilization after EGS among rural patients.

Using the 2016 to 2022 National Inpatient Sample, we conducted a retrospective cohort study identifying hospitalizations of adult patients from rural areas, using the National Center for Health Statistics urban-rural classification scheme, who underwent selected EGS procedures. Factors associated with PACS utilization, defined as discharge to home healthcare or other intermediate care facilities (including intermediate care facilities and skilled nursing facilities), were evaluated. Adjusted multinomial logistic regression models were estimated, controlling for demographic and clinical characteristics.

There were more than 1,148,000 EGS hospitalizations in the United States for rural patients, of which 28.9% used PACS. CMS was the primary payer for 82% of the hospitalizations using PACS. Factors that were significantly predictive of higher use of any type of PACS utilization included older age, greater comorbidities, increased length of stay, Medicare or Medicaid payer, large-bowel procedures, hospital location in the Northeast or South, operative complications, and transferred-in status.

In one of the largest evaluations of PACS utilization after EGS, approximately one-third of hospitalizations of rural patients received PACS after EGS. Surgeons, healthcare systems, and CMS can leverage these results to accurately predict which patients will require PACS and how best to improve its utilization for rural patients.