Surgical Services

A University of Michigan-led team carried out an analysis of data from 1.6 million hospital stays for four common operations: gallbladder removal, colon surgery, hernia repair and appendectomy. They compared what happened to patients covered by Medicare who had their operations at 828 critical access hospitals with data from patients treated at more than 3,600 larger hospitals.

The analysis yielded several surprises:

• The risk of dying within 30 days of the operation was the same whether a patient had surgery at a critical access hospital or a larger hospital.
• The risk of suffering a major complication after surgery, such as a heart attack, pneumonia or kidney damage, was lower at critical access hospitals.
• Patients who had their operation at a critical access hospital cost the Medicare system nearly $1,400 less than patients who had the same operation at a larger hospital, after differences in patient risk and pricing were accounted for.
• The patients who had these operations at critical access hospitals were healthier to begin with than patients treated elsewhere, suggesting that critical access hospital surgeons are appropriately selecting surgical patients who can do well in a small rural setting, and triaging more complex patients to larger centers.
• But even after the researchers corrected for differences in pre-operation health, the critical access hospitals still had equal or better outcomes.
• Fewer than 5 percent of surgery patients at critical access hospitals were transferred to larger hospitals, compared with more than a quarter of patients treated for nonsurgical issues, according to other studies.
• Critical access hospital surgery patients were less likely to use skilled nursing facilities after their operations.