Acute Care/Hospitalization

Regionalization of high-risk surgeries may not result in loss of patients or revenue from small rural hospitals

To improve the quality of surgery in the United States, patients undergoing high-risk surgeries are often sent to regional hospitals that perform a high volume of such surgeries. Concerns that this regionalization of high-risk surgeries might have a negative impact on small rural hospitals may be unfounded, according to a study of hospitals in New York. Small (less than 50 beds) rural New York hospitals gained only 2 percent of net revenue from 9 high-risk surgeries, most of which was due to colectomy surgery (removal of part or all of the colon). Thus, regionalization of colectomy would only have a small impact on the inpatient volume and revenue of rural hospitals, note the researchers.

They used data from the Healthcare Cost and Utilization Project to identify all admissions from 1998 to 2001 to small rural hospitals in New York that performed nine high-risk surgeries: abdominal aortic aneurysm repair, aortic valve replacement, carotid endarterectomy (removal of plaque from the carotid artery), colectomy, coronary artery bypass graft surgery, and surgeries to remove all or part of the bladder (cystectomy), esophagus (esophagectomy), pancreas (pancreatectomy), and lungs (pulmonary resection). They calculated total charges related to each admission and source of payment.

Together, these small rural hospitals performed a total of 643 colectomies and 55 carotid endarterectomies during the 3-year period, and performed a total of only 2 to 14 of the other high-risk surgeries during that time. Colectomy accounted for an average of nearly 2 percent of total inpatient revenue compared with less than 0.2 percent for the remaining high-risk procedures evaluated in the study. The study was supported in part by the Agency for Healthcare Research and Quality (HS00044).

See "Small rural hospitals and high-risk operations: How would regionalization affect surgical volume and hospital revenue?" by Andre R. Chappel, B.A., Randall S. Zuckerman, M.D., F.A.C.S., and Samuel R. Finlayson, M.D., M.P.H, F.A.C.S., in the November 2006 Journal of the American College of Surgeons 203, pp. 599-604.

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