Abstract
Background
Approximately 20% of the U.S. population resides in rural areas where health care access is limited by physician shortages. This presents a disparity in emergency general surgery where timely intervention is essential. This study aims to evaluate the impact of rurality on outcomes of emergency general surgery patients transferred to a metropolitan center.
Methods
A retrospective single-center cohort study of 1189 patients who underwent non-traumatic emergent exploratory laparotomies. Patient rurality was determined by Rural-Urban Commuting Area (RUCA) codes which categorize patients as metropolitan, micropolitan, small town, or rural. The primary outcome was in-hospital mortality.
Results
Rural (n = 369) and small-town (n = 135) patients had similar preoperative comorbidities, Physiological Emergency Surgery Acuity Scores (PESAS), utilization of damage control laparotomies, ICU metrics, and outcomes compared to those that presented to a metropolitan center (n = 508). In contrast, micropolitan (n = 177) patients had higher PESAS scores (5 vs 3, P < 0.0001) and underwent more damage control laparotomies (62% vs 40%–49%, P < 0.0001) with higher use of intraoperative vasopressors (57% vs 37%–39%, P < 0.001) and higher overall mortality (23% vs 13%–15%, P = 0.027).
Discussion
Our findings suggest that a mature and centralized transfer system promotes equity of outcomes between rural and metropolitan emergency general surgery patients. Micropolitan patients were more acuity ill than patients of other degrees of rurality, which suggests that low acuity micropolitan patients were more likely to be managed within their own communities.
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