In a study appearing in the May 17 issue of JAMA, Andrew M. Ibrahim, M.D., of the University of Michigan, Ann Arbor, and colleagues compared the surgical outcomes and associated Medicare payments at critical access hospitals vs non-critical access hospitals.

Critical access hospital designation was created to help ensure access to the more than 59 million people living in rural populations. Previous reports suggest these centers provide lower quality of care for common medical admissions. Little is known about the outcomes and costs of patients admitted for surgical procedures.

This study included a review of 1,631,904 Medicare beneficiary admissions to critical access hospitals (n = 828) and non-critical access hospitals (n = 3,676) for 1 of 4 common types of surgical procedures: appendectomy, gall bladder removal, removal of all or part of the colon, and hernia repair. The researchers compared risk-adjusted outcomes and adjusted for patient factors, admission type (elective, urgent, emergency), and type of operation.

Patients (average age, 77 years) undergoing surgery at critical access hospitals were less likely to have chronic medical problems, and they had lower rates of heart failure (7.7 percent vs 10.7 percent), diabetes (20 percent vs 22 percent), obesity (6.5 percent vs 10.6 percent), or multiple co-existing diseases (percent of patients with 2 or more comorbidities; 60 percent vs 70 percent). After adjustment for patient factors, critical access and non-critical access hospitals had no statistically significant differences in 30-day mortality rates (5.4 percent vs 5.6 percent).

Critical access vs non-critical access hospitals had significantly lower rates of serious complications (6 percent vs 14 percent). Medicare expenditures adjusted for patient factors and procedure type were lower at critical access hospitals than non-critical access hospitals ($14,450 vs $15,845).

"This study had 2 principal findings regarding how surgical care is delivered at critical access hospitals. First, the study found that performance of 4 common surgical procedures at critical access hospitals was associated with no difference in 30-day mortality and lower complication rates compared with non-critical access hospitals," the authors write.

"Second, despite the reimbursement structure for critical access hospitals established in the Medicare Rural Hospital Flexibility Program, there was no evidence of higher expenditures for common surgical procedures. Both of these findings contrast previously published literature about nonsurgical admissions in these same settings and inform legislators about the valuable role critical access hospitals provide in the U.S. health care system."