BACKGROUND: Rurality adversely impacts the continuum of cancer care. However, investigations of rural cancer surgery are notably absent. We examined patterns and outcomes of oncologic resections at rural US hospitals. METHODS: We identified 928,370 hospital admissions in which 1 of 20 oncologic resections was performed using the 1998 to 2009 Nationwide Inpatient Sample. Logistic regression examined predictors of rurality and the adjusted likelihood of in-hospital mortality at rural and urban hospitals. RESULTS: The fraction of procedures performed at rural hospitals decreased from 12% to 6%. Older age, non-Hispanic white race, and fewer comorbidities predicted rurality. Rural hospitals did not have worse mortality, however, rurality significantly augmented mortality among recipients of complex cancer surgery. CONCLUSIONS: Rural hospitals had comparable mortality overall, but delivered poorer outcomes for certain groups. Future research should explore these variations as cancer care is increasingly centralized. Published by Elsevier Inc.
BACKGROUND: Rurality adversely impacts the continuum of cancer care. However, investigations of rural cancer surgery are notably absent. We examined patterns and outcomes of oncologic resections at rural US hospitals. METHODS: We identified 928,370 hospital admissions in which 1 of 20 oncologic resections was performed using the 1998 to 2009 Nationwide Inpatient Sample. Logistic regression examined predictors of rurality and the adjusted likelihood of in-hospital mortality at rural and urban hospitals. RESULTS: The fraction of procedures performed at rural hospitals decreased from 12% to 6%. Older age, non-Hispanic white race, and fewer comorbidities predicted rurality. Rural hospitals did not have worse mortality, however, rurality significantly augmented mortality among recipients of complex cancer surgery. CONCLUSIONS: Rural hospitals had comparable mortality overall, but delivered poorer outcomes for certain groups. Future research should explore these variations as cancer care is increasingly centralized. Published by Elsevier Inc.
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