Half Of Rural Patients Bypassed Their Local Hospital But Received Lower-Quality Surgical Care Elsewhere, 2016–20

Hospital bypass, where patients receive care at a more distant hospital rather than their local hospital, has been described in the literature, but little is known about its association with surgical quality. Using data from the Medicare Provider Analysis and Review file and the American Hospital Association Annual Survey, we designed a retrospective cohort study of rural Medicare beneficiaries who underwent appendectomy, cholecystectomy, colectomy, or hernia repair during the period 2016-20, and we compared outcomes between those who bypassed their nearest surgery-capable hospital and those who did not, accounting for patient characteristics, hospital characteristics, and year of surgery. We found that 49 percent of rural beneficiaries bypassed their nearest surgery-capable hospital to receive surgical care elsewhere. Beneficiaries who bypassed had higher rates of in-hospital mortality, serious complications, and thirty-day readmissions, despite going to larger hospitals with more resources. Notably, these findings were preserved when we specifically analyzed both unplanned and elective admissions. These findings have important implications for surgical quality among rural patients and struggling rural hospitals, which may be able to alleviate some of their financial vulnerability by retaining larger proportions of these patients locally.