From the Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Burney, Baumann, Briggs).
Geisel School of Medicine at Dartmouth, Hanover, NH (Burney, Baumann, Carlos, Briggs).
J Am Coll Surg. 2023 Jun 1;236(6):1105-1109. doi: 10.1097/XCS.0000000000000501. Epub 2022 Dec 8.
Geriatric patients requiring emergency general surgery (EGS) have significant risk of morbidity and mortality. Rural patients face decreased access to care. We sought to characterize the EGS needs and impact of rurality for geriatric residents of New Hampshire.
A retrospective cohort study of the New Hampshire Uniform Healthcare Facility Discharge Dataset, including patients 65 years and older with urgent/emergent admission who underwent 1 of 7 EGS procedures, grouped by urban or rural county of residence, discharged between 2012-2015.
New Hampshire has 26 acute care hospitals: 10 (38.5%) are in urban counties and 16 (61.5%) are in rural counties. Thirteen (50.0%) are critical access hospitals (1 urban and 12 rural). Of 2,445 geriatric patient discharges, 40% of patients were from rural counties and were demographically similar to urban patients. Rural patients were more likely to present as a hospital transfer (15.4% vs 2.5%, p < 0.01), receive care at a critical access hospital (24.1% vs 1.0%, p < 0.01), receive care outside their home county (32.5% vs 12.8%, p < 0.01), and be transferred to another hospital after surgery. Rural and urban patients underwent similar procedures, with similar lengths of stay, cost of index hospitalization, and mortality.
Rural geriatric patients in New Hampshire are more likely to receive care outside of their home county or be transferred to another hospital. Costs of care were similar but are likely underestimated for rural patients. There was no difference in unadjusted mortality. Further investigation is merited to determine the reasons for hospital transfer in the geriatric EGS population to evaluate which patients may benefit most from remaining close to home vs transferring to other facilities.
需要紧急普通外科手术（EGS）的老年患者有较高的发病率和死亡率。农村患者获得医疗服务的机会减少。我们旨在描述新罕布什尔州老年居民的 EGS 需求和农村因素的影响。
这是一项对新罕布什尔州统一医疗设施出院数据集的回顾性队列研究，纳入了 2012 年至 2015 年间因紧急/紧急入院且接受了 7 种 EGS 之一的 65 岁及以上的患者，按居住的城市或农村县进行分组。
新罕布什尔州有 26 家急性护理医院：10 家（38.5%）位于城市县，16 家（61.5%）位于农村县。其中 13 家（50.0%）为基层医疗保健医院（1 家城市，12 家农村）。在 2445 名老年患者出院患者中，40%的患者来自农村县，与城市患者的人口统计学特征相似。农村患者更有可能是医院转院（15.4%比 2.5%，p<0.01），在基层医疗保健医院接受治疗（24.1%比 1.0%，p<0.01），在其居住地以外的县接受治疗（32.5%比 12.8%，p<0.01），并在手术后转至另一家医院。农村和城市患者接受了类似的手术，住院时间、住院费用和死亡率相似。
新罕布什尔州的农村老年患者更有可能在其居住地以外的地方接受治疗或转至另一家医院。治疗费用相似，但农村患者的费用可能被低估。未经调整的死亡率没有差异。需要进一步调查以确定老年 EGS 人群中转院的原因，以评估哪些患者最受益于留在离家较近的地方或转至其他医疗机构。
