title: Utilization and outcomes of inpatient surgical care at critical access hospitals in the United States.
abstract: OBJECTIVE
  There is a growing interest in the quality and cost of care provided at Critical Access Hospitals (CAHs), a predominant source of care for many rural populations in the United States.
  
  
  OBJECTIVE
  To evaluate utilization, outcomes, and costs of inpatient surgery performed at CAHs.
  
  
  METHODS
  A retrospective cohort study of patients undergoing inpatient surgery from 2005 through 2009 at CAHs or non-CAHs was performed using data from the Nationwide Inpatient Sample and American Hospital Association.
  
  
  METHODS
  The CAH status of the admitting hospital.
  
  
  METHODS
  In-hospital mortality, prolonged length of stay, and total hospital costs.
  
  
  RESULTS
  Among the 1283 CAHs and 3612 non-CAHs reporting to the American Hospital Association, 34.8% and 36.4%, respectively, had at least 1 year of data in the Nationwide Inpatient Sample. General surgical, gynecologic, and orthopedic procedures composed 95.8% of inpatient cases at CAHs vs 77.3% at non-CAHs (P < .001). For 8 common procedures examined (appendectomy, cholecystectomy, colorectal cancer resection, cesarean delivery, hysterectomy, knee replacement, hip replacement, and hip fracture repair), mortality was equivalent between CAHs and non-CAHs (P > .05 for all), with the exception that Medicare beneficiaries undergoing hip fracture repair in CAHs had a higher risk of in-hospital death (adjusted odds ratio = 1.37; 95% CI, 1.01-1.87). However, despite shorter hospital stays (P ≤ .001 for 4 procedures), costs at CAHs were 9.9% to 30.1% higher (P < .001 for all 8 procedures).
  
  
  CONCLUSIONS
  In-hospital mortality for common low-risk procedures is indistinguishable between CAHs and non-CAHs. Although our findings suggest the potential for cost savings, changes in payment policy for CAHs could diminish access to essential surgical care for rural populations.
authors: Department of Urology, University of Michigan Health System, Ann Arbor, MI 48109, USA.
authors: Adam J
authors: AJ
authors: Gadzinski
authors: Justin B
authors: JB
authors: Dimick
authors: Zaojun
authors: Z
authors: Ye
authors: David C
authors: DC
authors: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings; D005260:Female; D006297:Health Services Accessibility; D017721:Hospital Costs; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States
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