Rural Residence and Postsurgical Outcomes Among Medicare Beneficiaries.
Rural Medicare patients had higher 30-day mortality after common general surgery procedures.
Rural Residence and Postsurgical Outcomes Among Medicare Beneficiaries.
IMPORTANCE: Rural hospital-level surgical quality has been extensively evaluated.
To evaluate surgical quality among rural vs nonrural Medicare beneficiaries undergoing common general surgery procedures.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used 100% Medicare inpatient claims linked with the American Hospital Association Annual Survey between 2016 and 2023.
rural patients had 21% higher odds of death within 30 days
Among 2 317 497 beneficiaries (55.5% female; mean [SD] age, 75.2 [7.2] years), 462 358 (19.9%) were rural.
Rural patients were more often male (46.4% vs 44.1%) and traveled longer for surgery (median, 45.0 [IQR, 22.0-77.0] minutes vs 20.0 [IQR, 13.0-31.0] minutes).
Complication rates were higher (29.31% [95% CI, 29.04%-29.57%] vs 28.58% [95% CI, 28.40%-28.76%]; OR, 1.05 [95% CI, 1.03-1.07]; P < .001).
In this cohort study of Medicare beneficiaries undergoing common general surgery procedures, rural residence was independently associated with worse clinical outcomes across most measures.
These findings identify significant opportunities for quality improvement focused on common rural surgical needs.