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Geographic Distribution of Adult Inpatient Surgery Capability in the USA

  • Adrian Diaz
  • Anna Schoenbrunner
  • Jordan Cloyd
  • Timothy M. PawlikEmail author
Original Article

Abstract

Introduction

Access to timely, quality, and affordable surgical services is an important component of health care systems. A better understanding of the geographic distribution of surgical services in the USA may help identify disparities in access to surgery.

Methods

Using the 2015 American Hospital Association Annual Survey, the 2010 Census Bureau Data, and the American Community Survey 5-year estimates from 2011 to 2016, all hospitals with surgical capabilities were geocoded with 30 straight-line mile service areas around each hospital using geospatial analysis. Major surgical hospitals were defined as meeting three of the four following criteria: bed size ≥ 45, ≥ 8600 operations per year, ≥ 12 operating rooms, and academic medical center. The distribution of the US population based on proximity to a hospital capable of performing adult inpatient surgery and a major surgical hospital was then analyzed and compared.

Results

Overall, 3409 hospitals were identified that had the capacity to perform adult inpatient surgery of which 1373 were defined as major surgical hospitals. Based on geospatial analysis, 10% of the US population was found to reside outside of a linear 30-mile radius of a surgical hospital. Younger age (OR 0.97, CI 0.96–0.97), female sex (OR 4.6, CI 4.3–5), African-American race (OR = 5.4, CI 4.7–6.2), Hispanic/Latino race (OR 5.5, CI 4.8–6.3), having completed high school or greater (OR = 3.6, CI 3–4.2), being employed (OR 4.8, CI 4.6–4.9), and having any type of health insurance were significantly associated with living in a service area.

Conclusion

A significant proportion of the US population lives greater than 30 straight-line miles from a major surgical hospital. Common demographic and socioeconomic factors highlight disparities in access to surgical care.

Keywords

Access Geospatial Surgery Location USA 

Notes

Supplementary material

11605_2018_4078_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 21 kb)

References

  1. 1.
    Levy H, Janke A. Health Literacy and Access to Care. J Health Commun. 2016;21 Suppl 1:43–50.CrossRefGoogle Scholar
  2. 2.
    Schoen C, Osborn R, Squires D, Doty MM. Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. Health Aff Proj Hope. 2013 Dec;32(12):2205–15.CrossRefGoogle Scholar
  3. 3.
    Farley DO, Shugarman LR, Taylor P, Inkelas M, Ashwood JS, Zeng F, et al. Trends in Special Medicare Payments and Service Utilization for Rural Areas in the 1990s [Internet]. 2002 [cited 2018 Jan 11]. Available from: https://www.rand.org/pubs/monograph_reports/MR1595.html
  4. 4.
    Pfuntner A, Wier LM, Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2011: Statistical Brief #165. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 [cited 2017 Nov 24]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK174682/
  5. 5.
    Ellison EC, Pawlik TM, Way DP, Satiaini B, Williams TE. The impact of the aging population and incidence of cancer on future projections of general surgical workforce needs. Surgery. 2017 Nov 24;Google Scholar
  6. 6.
    Williams TE, Ellison EC. Population analysis predicts a future critical shortage of general surgeons. Surgery. 2008 Oct;144(4):548–554-556.CrossRefGoogle Scholar
  7. 7.
    Young J, Thompson A, Tait I, Waugh L, McPhillips G. Centralization of services and reduction of adverse events in pancreatic cancer surgery. World J Surg. 2013 Sep;37(9):2229–33.CrossRefGoogle Scholar
  8. 8.
    Chhabra KR, Dimick JB. Strategies for Improving Surgical Care: When Is Regionalization the Right Choice?. JAMA Surg. 2016 01;151(11):1001–2.Google Scholar
  9. 9.
    Cecil G. Sheps Center for Health Services Research. 83 Rural Hospital Closures: January 2010 – Present [Internet]. Cecil G. Sheps Center for Health Services Research The University of North Carolina at Chapel Hill. [cited 2018 May 2]. Available from: https://www.google.com/maps/d/viewer?mid=14JRLTb-C3ptk8tgGG3bUdKISZlA
  10. 10.
    Kaufman BG, Thomas SR, Randolph RK, Perry JR, Thompson KW, Holmes GM, et al. The Rising Rate of Rural Hospital Closures. J Rural Health Off J Am Rural Health Assoc Natl Rural Health Care Assoc. 2016;32(1):35–43.CrossRefGoogle Scholar
  11. 11.
    Schmitt M. Do hospital mergers reduce costs?. J Health Econ. 2017 Mar;52:74–94.CrossRefGoogle Scholar
  12. 12.
    Zogg CK, Scott JW, Jiang W, Wolf LL, Haider AH. Differential access to care: The role of age, insurance, and income on race/ethnicity-related disparities in adult perforated appendix admission rates. Surgery. 2016;160(5):1145–54.CrossRefGoogle Scholar
  13. 13.
    De Oliveira GS, McCarthy RJ, Wolf MS, Holl J. The impact of health literacy in the care of surgical patients: a qualitative systematic review. BMC Surg [Internet]. 2015 Jul 17 [cited 2018 May 31];15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504415/
  14. 14.
    Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011 Jun 2;364(22):2128–37.CrossRefGoogle Scholar
  15. 15.
    Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003 Nov 27;349(22):2117–27.CrossRefGoogle Scholar
  16. 16.
    Buettner S, Gani F, Amini N, Spolverato G, Kim Y, Kilic A, et al. The relative effect of hospital and surgeon volume on failure to rescue among patients undergoing liver resection for cancer. Surgery. 2016 Apr;159(4):1004–12.CrossRefGoogle Scholar
  17. 17.
    Xu Z, Becerra AZ, Justiniano CF, Boodry CI, Aquina CT, Swanger AA, et al. Is the Distance Worth It? Patients With Rectal Cancer Traveling to High-Volume Centers Experience Improved Outcomes. Dis Colon Rectum. 2017 Dec;60(12):1250–9.CrossRefGoogle Scholar
  18. 18.
    Paquette IM, Zuckerman R, Finlayson SRG. Perforated appendicitis among rural and urban patients: implications of access to care. Ann Surg. 2011 Mar;253(3):534–8.CrossRefGoogle Scholar
  19. 19.
    Kelly C, Hulme C, Farragher T, Clarke G. Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review. BMJ Open. 2016 24;6(11):e013059.CrossRefGoogle Scholar
  20. 20.
    Giuliani O, Mancini S, Puliti D, Caranci N, Ravaioli A, Vattiato R, et al. Patterns and determinants of receipt of follow-up mammography and/or clinical examination in a cohort of Italian breast cancer survivors. Breast Cancer Res Treat. 2016;158(3):543–51.CrossRefGoogle Scholar
  21. 21.
    Onitilo AA, Liang H, Stankowski RV, Engel JM, Broton M, Doi SA, et al. Geographical and seasonal barriers to mammography services and breast cancer stage at diagnosis. Rural Remote Health. 2014;14(3):2738.Google Scholar
  22. 22.
    Agency for Healthcare Research and Quality. HCUP NIS Description of Data Elements. Healthcare Cost and Utilization Project (HCUP) [Internet]. 2008. Available from: https://www.hcup-us.ahrq.gov/db/vars/hosp_bedsize/nisnote.jsp
  23. 23.
    Status of State Action on the Medicaid Expansion Decision [Internet]. The Henry J. Kaiser Family Foundation. 2018 [cited 2018 May 6]. Available from: https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/
  24. 24.
    Belsky D, Ricketts T, Poley S, Gaul K. Surgical deserts in the U.S.: counties without surgeons. Bull Am Coll Surg. 2010 Sep;95(9):32–5.Google Scholar
  25. 25.
    Khubchandani JA, Shen C, Ayturk D, Kiefe CI, Santry HP. Disparities in access to emergency general surgery care in the United States. Surgery. 2018 Feb;163(2):243–50.CrossRefGoogle Scholar
  26. 26.
    Jr T, D S. Socioeconomic, Geospatial, and Geopolitical Disparities in Access to Health Care in the US 2011–2015. Int J Environ Res Public Health. 2017 May 29;14(6):573.CrossRefGoogle Scholar
  27. 27.
    Knowlton LM, Banguti P, Chackungal S, Chanthasiri T, Chao TE, Dahn B, et al. A geospatial evaluation of timely access to surgical care in seven countries. Bull World Health Organ. 2017 Jun 1;95(6):437–44.CrossRefGoogle Scholar
  28. 28.
    Smith ER, Vissoci JRN, Rocha TAH, Tran TM, Fuller AT, Butler EK, et al. Geospatial analysis of unmet pediatric surgical need in Uganda. J Pediatr Surg. 2017 Oct;52(10):1691–8.CrossRefGoogle Scholar
  29. 29.
    Esquivel MM, Uribe-Leitz T, Makasa E, Lishimpi K, Mwaba P, Bowman K, et al. Mapping Disparities in Access to Safe, Timely, and Essential Surgical Care in Zambia. JAMA Surg. 2016 Nov 1;151(11):1064–9.CrossRefGoogle Scholar
  30. 30.
    Neuwahl S, Ricketts T, Holmes M. The impact of general surgeon supply on the risk of appendiceal rupture in North Carolina. Ann Surg. 2014 May;259(5):910–5.CrossRefGoogle Scholar
  31. 31.
    Turrentine FE, Buckley PJ, Sohn M-W, Williams MD. Travel Time Influences Readmission Risk: Geospatial Mapping of Surgical Readmissions. Am Surg. 2017 Jun 1;83(6):573–82.Google Scholar
  32. 32.
    Cloyd JM, Huang L, Ma Y, Rhoads KF. Predictors of readmission to non-index hospitals after colorectal surgery. Am J Surg. 2017 Jan;213(1):18–23.CrossRefGoogle Scholar
  33. 33.
    Jackson KL, Glasgow RE, Hill BR, Mone MC, Sklow B, Scaife CL, et al. Does travel distance influence length of stay in elective colorectal surgery?. Dis Colon Rectum 2013 Mar;56(3):367–73.CrossRefGoogle Scholar
  34. 34.
    Jackson KL, Glasgow RE, Mone MC, Sheng X, Mulvihill SJ, Scaife CL. Does travel distance influence length of stay in elective pancreatic surgery?. HPB. 2014 Jun;16(6):543–9.CrossRefGoogle Scholar
  35. 35.
    Finlayson SR, Birkmeyer JD, Tosteson AN, Nease RF. Patient preferences for location of care: implications for regionalization. Med Care. 1999 Feb;37(2):204–9.CrossRefGoogle Scholar
  36. 36.
    Yamamoto K, Fushimi K. Travel of patients to distant hospitals for elective surgery in Japan: a cross-sectional analysis of a nationally representative sample. Surg Today. 2009;39(9):758–63.CrossRefGoogle Scholar
  37. 37.
    Schermerhorn ML, Buck DB, O’Malley AJ, Curran T, McCallum JC, Darling J, et al. Long-Term Outcomes of Abdominal Aortic Aneurysm in the Medicare Population. N Engl J Med. 2015 Jul 23;373(4):328–38.CrossRefGoogle Scholar
  38. 38.
    Steinbrook R. Public report cards--cardiac surgery and beyond. N Engl J Med. 2006 Nov 2;355(18):1847–9.CrossRefGoogle Scholar
  39. 39.
    O’Connor GT, Plume SK, Olmstead EM, Morton JR, Maloney CT, Nugent WC, et al. A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. JAMA. 1996 Mar 20;275(11):841–6.Google Scholar
  40. 40.
    Ibrahim AM, Hughes TG, Thumma JR, Dimick JB. Association of Hospital Critical Access Status With Surgical Outcomes and Expenditures Among Medicare Beneficiaries. JAMA. 2016 May 17;315(19):2095–103.CrossRefGoogle Scholar
  41. 41.
    Alvino DML, Chang DC, Adler JT, Noorbakhsh A, Jin G, Mullen JT. How Far Are Patients Willing to Travel for Gastrectomy?. Ann Surg. 2017;265(6):1172–7.CrossRefGoogle Scholar
  42. 42.
    Fong ZV, Loehrer AP, Fernández-Del Castillo C, Bababekov YJ, Jin G, Ferrone CR, et al. Potential impact of a volume pledge on spatial access: A population-level analysis of patients undergoing pancreatectomy. Surgery. 2017;162(2):203–10.CrossRefGoogle Scholar
  43. 43.
    Lindrooth RC, Perraillon MC, Hardy RY, Tung GJ. Understanding The Relationship Between Medicaid Expansions And Hospital Closures. Health Aff (Millwood). 2018 Jan 1;37(1):111–20.CrossRefGoogle Scholar
  44. 44.
    Morse S. More than 200 rural hosptials are close to closure [Internet]. Healthcare Finacne. [cited 2018 May 4]. Available from: https://healthcarefinance.carto.com/viz/d25bb5f4-cab1-11e5-a458-0ecfd53eb7d3/embed_map
  45. 45.
    Boscoe FP, Henry KA, Zdeb MS. A Nationwide Comparison of Driving Distance Versus Straight-Line Distance to Hospitals. Prof Geogr J Assoc Am Geogr [Internet]. 2012 Apr 1 [cited 2018 May 7];64(2). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835347/
  46. 46.
    Spielman SE, Folch D, Nagle N. Patterns and causes of uncertainty in the American Community Survey. Appl Geogr Sevenoaks Engl. 2014 Jan;46:147–57.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  1. 1.Division of Surgical OncologyThe Ohio State University Wexner Medical Center and James Comprehensive Cancer CenterColumbusUSA
  2. 2.Department of Plastic SurgeryThe Ohio State UniversityColumbusUSA
  3. 3.Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer ResearchThe Ohio State University, Wexner Medical CenterColumbusUSA

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