University of Massachusetts Medical School Faculty Publications

Title

Disparities in access to emergency general surgery care in the United States

UMMS Affiliation

Department of Surgery; Department of Quantitative Health Sciences; Senior Scholars Program; School of Medicine

Publication Date

2018-02-01

Document Type

Article

Disciplines

Health and Medical Administration | Health Services Administration | Surgery

Abstract

BACKGROUND: As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities.

METHODS: To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and > /=1 "operating room." Internet search and direct contact confirmed emergency general surgery services that covered the emergency room 7 days a week, 24 hours a day. Geographic and population-level emergency general surgery access was derived from Geographic Information Systems and US Census.

RESULTS: Of the 6,356 hospitals in the 2013 American Hospital Association database, only 2,811 were emergency general surgery hospitals. Counties with greater percentages of black, Hispanic, uninsured, and low-education individuals and rural counties disproportionately lacked access to emergency general surgery care. For example, counties above the 75th percentile of African American population (10.2%) had > 80% odds of not having an emergency general surgery hospital compared with counties below the 25th percentile of African American population (0.6%).

CONCLUSION: Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide.

Keywords

UMCCTS funding

DOI of Published Version

10.1016/j.surg.2017.07.026

Source

Surgery. 2018 Feb;163(2):243-250. doi: 10.1016/j.surg.2017.07.026. Epub 2017 Oct 16. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Surgery

PubMed ID

29050886

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