Abstract
BackgroundPrevious studies showed comparable outcomes for common in-patient general surgery operations, but it is unknown if this extends to outpatient operations. Our aim was to compare outpatient cholecystectomy outcomes between rural and urban hospitals. MethodsA retrospective cohort analysis was done using the Nationwide Ambulatory Surgery Sample for patients 20-years-and-older undergoing cholecystectomy between 2016 and 2018 at rural and urban hospitals. Survey-weighted multivariable regression analysis was performed with primary outcomes including use-of-laparoscopy, complications, and patient discharge disposition. ResultsThe most common indication for operation was cholecystitis in both hospital settings. On multivariable analysis, rural hospitals were associated with higher transfers to short-term hospitals (adjusted odds ratio [aOR] 2.40, 95%CI 1.61-3.58, p < 0.01) and complications (aOR 1.39, 95%CI 1.11-1.75, p < 0.01). No difference was detected with laparoscopy (aOR 1.93, 95%CI 0.73-5.13, p = 0.19), routine discharge (aOR 1.50, 95%C I0.91-2.45, p = 0.11), or mortality (aOR 3.23, 95%CI 0.10–100.0, p = 0.51). ConclusionsPatients cared for at rural hospitals were more likely to be transferred to short-term hospitals and have higher complications. No differences were detected in laparoscopy, routine discharge or mortality.
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