Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA.
National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
J Rural Health. 2022 Jun;38(3):650-659. doi: 10.1111/jrh.12596. Epub 2021 May 20.
We sought to determine whether colorectal cancer surgery can be done safely at rural hospitals. The current study compared outcomes among rural patients who underwent colon resection at rural and nonrural hospitals.
Medicare beneficiaries who underwent colon resection for cancer between 2013 and 2017 were identified using the Medicare Inpatient Standard Analytic Files. Patients and hospitals were designated as rural based on rural-urban continuum codes. Risk-adjusted postoperative outcomes and hospitalization spending were compared among patients undergoing resection at rural versus nonrural hospitals.
Among 3,937 patients who resided in a rural county and underwent colon resection for cancer, mean age was 76.3 (SD: 7.1) years and 1,432 (36.4%) patients underwent operative procedure at a rural hospital. On multivariable analyses, no differences in postoperative outcomes were noted among Medicare beneficiaries undergoing colon resection for cancer at nonrural versus rural hospitals. Specifically, the risk-adjusted probability of experiencing a postoperative complication at a nonrural hospital was 15.4% (95% CI: 14.1%-16.8%) versus 16.3% (95% CI: 14.2%-18.3%) at a rural hospital (OR 1.08, 95% CI: 0.85-1.38); 30-day mortality (nonrural: 2.9%, 95% CI: 2.2-3.6 vs rural: 3.5%, 95% CI: 2.4-4.5) was also comparable. In addition, price standardized, risk-adjusted expenditures were similar at nonrural ($18,610, 95% CI: $18,037-$19,183) and rural ($19,010, 95% CI: $18,630-$19,390) hospitals.
Among rural Medicare beneficiaries who underwent a colon resection for cancer, there were no differences in postoperative outcomes among nonrural versus rural hospitals. These findings serve to highlight the importance of policies and practice guidelines that secure safe, local surgical care, allowing rural clinicians to accommodate strong patient preferences while delivering high-quality surgical care.
我们旨在确定农村医院是否可以安全地进行结直肠癌手术。本研究比较了在农村和非农村医院接受结肠癌切除术的农村患者的结局。
利用 Medicare 住院标准分析文件，确定了 2013 年至 2017 年间接受结肠癌切除术治疗癌症的 Medicare 受益人的信息。根据城乡连续体代码，将患者和医院指定为农村。比较了在农村和非农村医院接受切除术的患者的术后风险调整结局和住院费用。
在 3937 名居住在农村县且因癌症接受结肠癌切除术的患者中，平均年龄为 76.3（SD：7.1）岁，1432 名（36.4%）患者在农村医院接受手术。多变量分析显示，在非农村医院接受结肠癌切除术的 Medicare 受益人的术后结局无差异。具体而言，非农村医院术后发生并发症的风险调整概率为 15.4%（95%CI：14.1%-16.8%），而农村医院为 16.3%（95%CI：14.2%-18.3%）（OR 1.08，95%CI：0.85-1.38）；30 天死亡率（非农村：2.9%，95%CI：2.2-3.6 vs 农村：3.5%，95%CI：2.4-4.5）也相似。此外，非农村医院（$18610，95%CI：$18037-$19183）和农村医院（$19010，95%CI：$18630-$19390）的价格标准化风险调整支出也相似。
在接受结肠癌切除术治疗癌症的农村 Medicare 受益人中，非农村医院与农村医院的术后结局无差异。这些发现强调了政策和实践指南的重要性，这些政策和实践指南确保了安全的、当地的手术护理，使农村临床医生能够满足患者强烈的偏好，同时提供高质量的手术护理。
