Rural Patients More Likely Than City Dwellers to
Have Common Surgeries
By Lindsey Tanner, The Associated Press
May 16, 2011
A surprising study of
nearly 46 million Medicare patients says older residents in rural areas
are more likely to have any of nine common surgeries than people in
Back surgery, hip and
knee replacements, and prostate removal were among the operations
performed more often in rural Medicare patients, the study found.
Emergency surgeries and elective operations alike were more common
among rural residents.
The results seem to
challenge the idea that city dwellers have better access to medical
care, but experts say the research raises more questions than it
"When I first saw the
result, I looked at it and said maybe I got it backwards," said lead
author Dr. Mark Francis, a researcher at Texas Tech University Health
Sciences Center in El Paso. The study doesn't indicate where rural
residents had surgery. It's likely many had to travel some distance,
which would be risky when urgent surgery is needed.
The study didn't report
on how the patients fared after their operations. Nor did it say
whether rural residents had worse health overall than city dwellers,
although some previous research has suggested that is generally true.
The authors say their
findings could mean that rural residents are sicker, getting treatment
they don't need, or more likely to delay treatment for aches and pains
until they worsen and require surgery.
It's also possible rural
residents have less access to non-surgical treatments, or view them as
less desirable. But the real reasons can't be gleaned from the study,
which was a data analysis on all Medicare patients in 2006.
Though the cases are five
years old, Francis said the results likely reflect current practice and
noted that he had found similar trends going back to the 1990s. He said
it's unlikely the recession had much impact because these patients are
covered by Medicare.
The researchers used ZIP
codes and a government classification system that designates regions on
a 10-point scale, with 1 being the most urban and 10 the most rural.
They compared surgery rates among residents in regions 7 to 10 — the
most rural — with the most urban areas.
The study was released
Monday in the Archives of Surgery.
Francis said colleagues
told him, "If you find a 5 percent difference, that would be a big
difference from a public health policy view." But the contrast between
the two groups was larger than that for all but one of the operations —
abdominal aortic aneurysms.
Rural residents were
almost 20 percent more likely to have heart valve replacements, and
about 15 percent more likely to get knee or hip replacements or spine
fusion surgery. Smaller but still noteworthy differences were found for
prostate surgery, appendectomies, surgery to remove neck artery
blockages, and surgery to fix broken hips.
An Archives critique says
the study raises hard questions.
"We have been led to
believe that patients in rural areas lack appropriate access to
surgery. Although this may be true for specific areas, it does not seem
to be true for the nation as a whole," Massachusetts General Hospital
surgeon Dr. George Velmahos wrote.
Dr. Sam Finlayson, a
Dartmouth Medical School surgeon and researcher, called the results
provocative but said, "I don't think this study can negate all of the
evidence that there are pockets of problems with access to surgical
care across rural America."
Other research has
suggested there's a growing shortage of surgeons in rural America. But
Keith Mueller, a rural health expert at the University of Iowa, said
the new study raises the "so what?" question if people lacking local
access can get surgery elsewhere. Even so, he said, it still may be
more appropriate to have more of those services locally.
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