A. Diaz1, A. Schoenbrunner1, A. Paredes1, J. Cloyd1, T. M. Pawlik1 1Ohio State University,Surgery,Columbus, OH, USA
Introduction: Despite the increased need and utilization of surgical procedures, Americans often face challenges in gaining access to appropriate health care that may be exacerbated by the closure and consolidation of hospitals. We sought to define trends in the geographic distribution of surgical services in the United States to assess possible geographic barriers and disparities in access to surgical care.
Methods: The 2005 and 2015 American Hospital Association (AHA) annual survey was used to identify hospitals with surgical capacity; the data were merged with 2010 Census Bureau data to identify the distribution of the United States population relative to hospital location. Specifically, geospatial analysis tools were used to examine a service area of 30- and 60-minutes real driving time surrounding each hospital to assess the population living outside a given service area. A major surgery hospital was defined as meeting three of four criteria: bed size ³45, ³upper bound of interquartile range (IQR) for operating rooms and operations per year, and academic medical center.
Results: While the number of hospitals that provided surgical services slightly decreased over the time periods examined (2005, n=3,791 vs. 2015, n=3,391) (p<0.001), the number of major surgery hospitals increased from 2005 (n=539) to 2015 (n=749). The number of academic medical centers also increased over time (2005, n=973 vs. 2015, n=1,063)(p<0.001). In addition, while in 2005 the mean number of ORs per hospital was 7.7 (IQR 2-10), by 2015 the mean number of ORs per hospital had increased to 9.4 (IQR 2-12) (p<0.001). In contrast, the mean annual number of operations per hospital remained the same (2005, n=6,321 (IQR 1,240–8,566) vs. 2015, n=6,600 (IQR 1,291–8,621))(p=0.15). The geographic location of hospitals that provided surgical services changed over time. Specifically, while in 2005 852 hospitals were located in a rural area, that number had decreased to 679 by 2015 (p<0.001). Furthermore, while 887 hospitals had a critical access hospital designation in 2005 that number had decreased to 827 by 2015 (p<0.001). Of particular note, from 2005 to 2015 there was an 82% increase in the number of people who lived further than 60 minutes from any hospital (p<0.001). However, the number of people who lived further than 60 minutes from a major surgery hospital decreased (p<0.001)(Table).
Conclusion: While the number of rural, critical access hospitals decreased over the last decade, the number of large, academic medical centers has increased. In turn, there has been an almost doubling in the number of people who live outside a 60 minute driving range to a hospital capable of performing surgery. These data highlight the trends of rural hospital closures, consolidation of hospitals, and regionalization of operative procedures that make access to surgery for certain patient populations increasingly challenging.
