Predictors of hospital bypass for rural residents seeking common elective surgery.
BACKGROUND: Surgical bypass occurs when rural residents receive surgical care at a nonlocal hospital. Given limited knowledge of current bypass rates, we evaluated rates and predictors of bypass for common procedures. METHODS: We used 2014 to 2016 all-payer claims data from the Healthcare Cost and Utilization Project State Inpatient Databases to study rural patients from 13 states who underwent 1 of 11 common elective surgical procedures. Bypass was measured by whether a patient received elective surgical care at the closest hospital offering the requested procedure or another nonlocal hospital. Bypass probability was then modeled as a function of patient-level and hospital-level characteristics. RESULTS: Of the 121,297 rural elective surgery visits in our sample, 78,268 (64.5%) bypassed their local hospital. Bypass rate was greatest for coronary artery bypass graft or valve replacement (74.8%) and lowest for laparoscopic cholecystectomy (53.7%). In addition, average bypass rate was greatest for surgeries with the highest risk of intraoperative blood loss and postoperative complications. The probability of bypass significantly (P < .001) increased for patients who were younger, privately insured, and lived farther from the closest hospital. In addition, the probability of bypass significantly (P < .001) increased for patients whose local hospital had fewer full-time equivalents, lower operating margin, and fewer recommendations from previous patients. CONCLUSION: Among rural patients seeking elective surgery, bypass of the local hospital was common among both low-risk and high-risk procedures. These findings suggest that there is a substantial amount of bypass, which may negatively impact a hospital's financial performance and, hence, wellbeing of the local community.
Duke Scholars
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- Surgery
- Postoperative Complications
- Humans
- Hospitals
- Health Care Costs
- Elective Surgical Procedures
- Blood Loss, Surgical
- 3202 Clinical sciences
- 1103 Clinical Sciences
Citation
Published In
DOI
EISSN
Publication Date
Volume
Issue
Start / End Page
Location
Related Subject Headings
- Surgery
- Postoperative Complications
- Humans
- Hospitals
- Health Care Costs
- Elective Surgical Procedures
- Blood Loss, Surgical
- 3202 Clinical sciences
- 1103 Clinical Sciences