For common surgeries, critical access hospitals are safer, less expensive, study shows

Even though critical access hospitals have been criticized in previous studies and reports suggesting they provide lower-quality care than their larger counterparts, a new study in JAMA shows critical access hospitals may offer safer, less expensive common surgeries to Medicare patients.

Researchers from the University of Michigan in Ann Arbor reviewed 828 Medicare beneficiary admissions to critical access hospitals for one of four common types of surgery (appendectomy, gall bladder removal, removal of all or part of the colon and hernia repair) and compared it with 3,676 admissions to non-critical access hospitals for the same procedures. They compared risk-adjusted outcomes and adjusted for patient factors, admission type and type of operation.

When they compared outcomes and cost, there was no statistically significant difference in 30-day mortality rates between critical access hospitals and non-critical access hospitals. Also, critical access hospitals had lower rates of serious complications (6.4 percent versus 13.9 percent) and lower Medicare expenditures than non-critical access hospitals ($14,450 versus $15,845).

While they did adjust for patient factors, the study authors did note critical access hospital patients were less medically complex.

"From a surgical standpoint, these hospitals appear to be doing exactly what we would want them to be doing: common operations on appropriately selected patients who are safe to stay locally for their care," said Andrew Ibrahim, MD, the study's first author.

Tyler Hughes, MD, a surgeon at McPherson (Kan.) Hospital, assisted Dr. Ibrahim and the researchers on the study. He added, "The goal of the rural surgeon is [to provide the] best care nearest home. Data to assure that the care in rural centers is both safe and cost effective is critical in the decisions the profession faces in providing care to the 20 percent of the U.S. population living in truly rural environments. This study gives credence to what rural surgeons long suspected — that well-done rural surgery is safe and cost effective."

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