Surgical mortality no worse at critical access hospitals

Patients undergoing eight commonly performed surgical procedures at critical access hospitals (CAH) are no more likely to die in the hospital than patients undergoing the same surgeries at non-CAHs, a study published online Wednesday in JAMA Surgery finds.

In-hospital mortality for general surgical, gynecologic and orthopedic procedures is "largely indistinguishable" between CAHs and larger, urban hospitals, the researchers concluded. Surgical care at CAHs costs somewhat more, but "payment reforms aimed at this issue will have to consider the implications for timely access to surgical care among rural populations," they added.

Patients were less likely to stay for longer periods at critical access hospitals, but costs for both elective and nonelective surgical admissions were 9.9 percent to 30 percent higher at CAHs. Those additional costs ranged from $679 for cesarean sections to $5,170 for colorectal cancer resection, the study found.

The only surgical area in which the JAMA Surgery study found higher CAH mortality rates was repairs of hip fractures, both for Medicare and private-insurance patients.

The findings come only a month after a separate study in the Journal of the American Medical Association found mortality rates for Medicare patients hospitalized for acute myocardial infarction, congestive heart failure and pneumonia rising at CAHs while dropping at other hospitals.

The researchers behind the JAMA Surgery study attributed the difference between the two findings to studying many surgical procedures that were elective, and therefore potentially less acute. They also noted they did not follow up on patients following discharge.

To learn more:
- read the study