Costs of Surgery at Critical Access Hospitals

May 4, 2013
Study Examines Utilization, Outcomes, Costs of Inpatient Surgery at Critical Access Hospitals

A study by Adam J. Gadzinski, M.D., M.S., of the University of Michigan, Ann Arbor, and colleagues examined the utilization, outcomes and costs of inpatient surgery performed at critical access hospitals (CAHs). (Online First)

Researchers performed a retrospective cohort study of patients undergoing inpatient surgery from 2005 through 2009 at CAHs or non-CAHs using data from the Nationwide Inpatient Sample and American Hospital Association. Among the 1,283 CAHs and 3,612 non-CAHs reporting to the American Hospital Association, 34.8 percent and 36.4 percent respectively, had at least one year of data in the Nationwide Inpatient Sample. The main outcome measures were in-hospital mortality, prolonged length of stay, and total hospital costs.

General surgical, gynecologic, and orthopedic procedures composed 95.8 percent of in-patient cases at CAHs versus 77.3 percent at non-CAHs. For eight common procedures examined, mortality was equivalent between CAHs and non-CAHs, with the exception that Medicare beneficiaries undergoing hip fracture repair in CAHs had a higher risk of in-hospital death. However, despite shorter hospital stays, costs at CAHs were 9.9 percent to 30.1 percent higher, the study finds.

“In-hospital mortality for common low-risk procedures is indistinguishable between CAHs and non-CAHs. Although our findings suggest the potential for cost savings, changes in payment policy for CAHs could diminish access to essential surgical care for rural populations,” the authors conclude.

(JAMA Surg. Published online May 1, 2013. doi: 10.1001/jamasurg.2013.1224.