Rural & Urban Differences in Surgeries

Previous investigations have shown that there are disparities in healthcare services provided to rural and urban residents. Removing these disparities has become a national priority because good healthcare shouldn’t depend on where people live. Disparities in care to rural residents can have important implications for how healthcare resources are allocated. For example, patient outcomes are typically better with hospitals and surgeons performing higher volumes of given procedures. Outlying rural hospitals may be performing lower volumes of these procedures, but it’s important to balance this with the need for these procedures if there are no nearby hospitals and surgeons. Rural Vs Urban Settings In an effort to better understand the association between receipt of greater and lesser discretionary surgeries among residents in rural versus urban settings, my colleagues and I conducted an analysis that was published in the May 2011 Archives of Surgery. In this analysis, we analyzed disparities between settings by looking at the incidences of several elective procedures (lumbar spine fusion, total hip and knee replacement surgery, and prostatectomy) as well as that of less discretionary procedures (abdominal aortic aneurysm repair [AAA], aortic valve replacement, non-incidental appendectomy, open reduction and internal fixation of the femur, and carotid endarterectomy [CEA]). According to our findings, rural Medicare beneficiaries were significantly more likely than their urban counterparts to undergo a wide variety of surgical procedures. These procedures ranged from those that were generally more discretionary, especially total joint replacement surgery and lumbar spine fusion, to those that were generally less discretionary, including CEA and appendectomy. The magnitude of this difference was also important to note. Rural patients were at least 20% more...