# Changes in surgical quality and access after rural hospital closures

## TL;DR

Closing rural hospitals doesn't worsen surgical quality but increases travel distances for patients, affecting access to timely care.

## Contribution

This study provides new evidence on the effects of rural hospital closures on surgical care quality and access using Medicare claims data.

## Key findings

- Rural hospital closures did not significantly affect surgical quality metrics like mortality and complications.
- Travel distances increased for patients who lost their nearest rural hospital, but not for those losing their second-nearest hospital.
- Unplanned surgery rates remained unchanged despite hospital closures.

## Abstract

There are rising concerns about the effects of rural hospital closure on access to and quality of care for impacted patients, but little remains known about surgical care. The objective of this study was to evaluate the association of hospital closure with outcomes and access to surgery for common surgical conditions. Using Medicare claims data from 2010–2020, we evaluated the impact of rural hospital closures on surgical quality and access for common operations (colectomy, cholecystectomy, appendectomy, and hernia repair). Using a dynamic difference-in-differences approach, we analyzed 36 884 and 41 185 beneficiaries who lost their nearest and second-nearest rural hospital, respectively. Our findings revealed no significant impacts on surgical quality as measured by 30-day mortality, complications, serious complications, reoperations, and readmissions. While rates of unplanned surgery did not change, median travel distance increased from 13.1 to 16.4 miles for beneficiaries who lost their nearest hospital but was unchanged for those losing their second-nearest hospital. These findings suggest that, while rural hospital closure does not adversely impact surgical quality, it does pose challenges in ensuring access to timely surgical care. Policymakers should consider tailored interventions to mitigate the persistent and growing travel disparities to obtain care in rural America.