EMERGENCY GENERAL SURGERY OUTCOMES AT CRITICAL ACCESS HOSPITALS COMPARED WITH RURAL NON-CRITICAL ACCESS AND URBAN HOSPITALS IN KENTUCKY (2016-2024)
Author(s)
Nawaf Albaqami, MS, Seyed M. Karimi, MS, PhD, Michael Egger, MD, MPH, Ryne Marshall, MD, FACS;
University of Louisville, Louisville, KY, USA
University of Louisville, Louisville, KY, USA
OBJECTIVES: Despite the Critical Access Hospital (CAH) designation intended to preserve rural access, evidence comparing emergency general surgery (EGS) outcomes across CAHs, rural non-CAHs, and urban hospitals remains limited. This study evaluated differences in EGS outcomes among rural residents treated across hospital types.
METHODS: We conducted a repeated cross-sectional observational study using Kentucky Health Facility and Services (KHFS) inpatient claims data (2016-2024). Adult rural residents (≥21 years) undergoing inpatient EGS were identified using ICD-10-PCS codes. Primary outcomes included routine discharge, post-acute care (PAC) use, and length of stay (LOS). The secondary outcome was a composite adverse outcome defined as death or hospice discharge or postoperative complication. High-dimensional fixed-effects regression models adjusted for patient demographics, Charlson Comorbidity Index (CCI), admission characteristics, and hospital factors, with county, year, and county-by-year fixed effects and hospital-level clustered standard errors. All analyses were a priori stratified by age group (<65 vs ≥65 years).
RESULTS: Among adults aged <65 years, CAH care was associated with lower PAC use and higher routine discharge compared with pooled non-CAHs (PAC: β= −0.041; routine discharge: β = 0.053; p ≤ .05), with larger differences observed relative to rural non-CAHs (PAC: β= −0.080; routine discharge: β= 0.091; p ≤ .01), and no significant differences relative to urban hospitals. Among adults aged ≥65 years, CAH care was associated with substantially lower PAC use compared with pooled non-CAHs, rural non-CAHs, and urban hospitals (β= −0.150 to −0.168; p ≤ .01), and higher routine discharge relative to pooled non-CAHs (β= 0.095; p ≤.05). Adverse outcomes and length of stay did not differ meaningfully across hospital types.
CONCLUSIONS: Treatment at CAHs was associated with lower PAC use and more favorable discharge disposition compared with non-CAH. These findings suggest that CAHs can deliver comparable EGS outcomes and support surgical access in rural communities.
METHODS: We conducted a repeated cross-sectional observational study using Kentucky Health Facility and Services (KHFS) inpatient claims data (2016-2024). Adult rural residents (≥21 years) undergoing inpatient EGS were identified using ICD-10-PCS codes. Primary outcomes included routine discharge, post-acute care (PAC) use, and length of stay (LOS). The secondary outcome was a composite adverse outcome defined as death or hospice discharge or postoperative complication. High-dimensional fixed-effects regression models adjusted for patient demographics, Charlson Comorbidity Index (CCI), admission characteristics, and hospital factors, with county, year, and county-by-year fixed effects and hospital-level clustered standard errors. All analyses were a priori stratified by age group (<65 vs ≥65 years).
RESULTS: Among adults aged <65 years, CAH care was associated with lower PAC use and higher routine discharge compared with pooled non-CAHs (PAC: β= −0.041; routine discharge: β = 0.053; p ≤ .05), with larger differences observed relative to rural non-CAHs (PAC: β= −0.080; routine discharge: β= 0.091; p ≤ .01), and no significant differences relative to urban hospitals. Among adults aged ≥65 years, CAH care was associated with substantially lower PAC use compared with pooled non-CAHs, rural non-CAHs, and urban hospitals (β= −0.150 to −0.168; p ≤ .01), and higher routine discharge relative to pooled non-CAHs (β= 0.095; p ≤.05). Adverse outcomes and length of stay did not differ meaningfully across hospital types.
CONCLUSIONS: Treatment at CAHs was associated with lower PAC use and more favorable discharge disposition compared with non-CAH. These findings suggest that CAHs can deliver comparable EGS outcomes and support surgical access in rural communities.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD96
Topic
Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, STA: Surgery