Rurality and cancer surgery in the United States

BackgroundRurality 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.MethodsWe 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.ResultsThe 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.ConclusionsRural hospitals had comparable mortality overall, but delivered poorer outcomes for certain groups. Future research should explore these variations as cancer care is increasingly centralized.