Rurality and cancer surgery in the United States.
BACKGROUND
Rurality adversely impacts the continuum of cancer care. However, investigations of rural cancer surgery are notably absent. We examined patterns and outcomes of oncologic resections at rural US hospitals.


METHODS
We identified 928,370 hospital admissions in which 1 of 20 oncologic resections was performed using the 1998 to 2009 Nationwide Inpatient Sample. Logistic regression examined predictors of rurality and the adjusted likelihood of in-hospital mortality at rural and urban hospitals.


RESULTS
The fraction of procedures performed at rural hospitals decreased from 12% to 6%. Older age, non-Hispanic white race, and fewer comorbidities predicted rurality. Rural hospitals did not have worse mortality, however, rurality significantly augmented mortality among recipients of complex cancer surgery.


CONCLUSIONS
Rural hospitals had comparable mortality overall, but delivered poorer outcomes for certain groups. Future research should explore these variations as cancer care is increasingly centralized.
Division of Surgical Oncology, The Surgical Outcomes Research Center, Department of Surgery, University of Minnesota and Minneapolis VAMC, Minneapolis, MN 55455, USA.
Abraham
A
Markin
Elizabeth B
EB
Habermann
Christopher J
CJ
Chow
Yanrong
Y
Zhu
Selwyn M
SM
Vickers
Waddah B
WB
Al-Refaie
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000706:statistics & numerical data* / Q000639:trends; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000706:statistics & numerical data* / Q000639:trends; D006786:Hospitals, Urban / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality / Q000601:surgery*; D012959:Socioeconomic Factors; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D016896:Treatment Outcome; D014481:United States