Rural Residence and Postsurgical Outcomes Among Medicare Beneficiaries
Cody Lendon Mullens1,2,3, Adrian Diaz4, Brooke C Bredbeck5
1Department of Surgery, University of Michigan, Ann Arbor.
JAMA Network Open
|August 6, 2026
Summary
Rural Medicare beneficiaries undergoing surgery have worse outcomes, including higher mortality and complication rates, compared to nonrural patients. These findings highlight critical areas for improving surgical care quality in rural America.
Area of Science:
- Health Services Research
- Surgical Quality Improvement
- Rural Health Disparities
Background:
- Rural populations face increasing healthcare inequities, with surgical care quality remaining poorly defined nationally.
- Existing evaluations of surgical quality have primarily focused on hospital-level metrics, not patient outcomes in rural settings.
Purpose of the Study:
- To compare surgical quality between rural and nonrural Medicare beneficiaries undergoing common general surgery procedures.
- To identify disparities in surgical outcomes based on patient residence.
Main Methods:
- Retrospective cohort study utilizing Medicare inpatient claims (2016-2023) linked with American Hospital Association data.
- Inclusion of beneficiaries aged 65-99 undergoing appendectomy, cholecystectomy, colectomy, or incisional hernia repair.
- Risk-adjusted analysis of 30-day mortality, in-hospital mortality, complications, readmissions, discharge disposition, and length of stay using multivariable logistic regression.
Main Results:
- The study analyzed 2,317,497 beneficiaries, with 19.9% residing in rural areas.
- Rural patients experienced higher adjusted 30-day mortality (6.78% vs 5.84%), in-hospital mortality (3.65% vs 3.20%), and 30-day readmission rates (14.31% vs 13.57%).
- Complication rates were elevated in rural patients (29.31% vs 28.58%), with lower rates of discharge home (75.56% vs 77.61%) and higher transfer rates to other facilities (1.40% vs 0.70%).
Conclusions:
- Rural residence is independently associated with worse clinical outcomes for Medicare beneficiaries undergoing common general surgery procedures.
- Significant opportunities exist for quality improvement initiatives targeting the surgical needs of rural populations.
- Addressing these disparities is crucial for achieving equitable surgical care across the United States.
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