A commonplace surgical procedure may be much safer and cheaper in "critical access" hospitals in rural areas than in high-traffic or suburban cities, a new study has suggested.

Specifically, four common operations such as hernia repair, gallbladder surgery, colon surgery and appendectomy may be cost-effective in remote hospitals because they are designed to improve health care access and keep essential services within secluded communities.

This conclusion by researchers from the University of Michigan is a deviation from the notion that higher-traffic hospitals are more likely to function better than those in rural areas.

However, it does affirm what rural surgeons have long suspected, said Dr. Tyler Hughes, author of the study.

"Well-done rural surgery is safe and cost-effective," said Hughes.

Reviewing The Risks

For the report, Hughes and his team reviewed about 1.6 million surgeries that were performed at 828 rural hospitals and 3,600 larger hospitals. They compared the prognosis of Medicare patients who went through one of the four common surgical procedures.

Researchers found that there was no difference between critical access hospitals and city hospitals when it comes to the risk of dying within the first 30 days after the surgical operation.

However, Hughes and his colleagues did find that the risk for developing complications such as kidney damage, pneumonia, or heart attack after an operation was lower in rural hospitals than in cities.

What's more, it has cost Medicare about $1,400 less for the same operation in rural hospitals compared with an operation in city hospitals.

Additional findings include the following:

- Patients in critical access hospitals were less likely to make use of skilled nursing facilities after operations.

- Patients in critical access hospitals who went through an operation tended to be healthier than their counterparts at larger hospitals. This suggests that surgeons in rural areas tend to choose low-risk surgical patients and send complex cases to larger hospitals.


Hughes, who is one of only two surgeons at McPherson Hospital in Kansas, said rural or critical access hospitals are the closest option of millions of patients that live outside suburban areas and major cities.

Dr. Justin Dimick, senior author of the study, said that although it makes more sense that patients travel to larger hospitals for more complex operations, their study shows that local surgery is still safer when it comes to common procedures.

The findings of the study are detailed in JAMA.

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