LAUSR

BACKGROUND Geriatric patients requiring Emergency General Surgery (EGS) have significant risk of morbidity and mortality. Rural patients face decreased access to care. We sought to characterize the EGS needs and impact of rurality for geriatric residents of New Hampshire (NH). STUDY DESIGN A retrospective cohort study of the NH Uniform Healthcare Facility Discharge Dataset, including patients 65 years-old and older with urgent/emergent admission who underwent one of 7 EGS procedures, grouped by urban or rural county of residence, discharged between 2012-2015. RESULTS NH has 26 acute care hospitals of which 10 (38.5%) are in urban counties and 16 (61.5%) are in rural counties. 13 (50.0%) are critical access hospitals (1 urban and 12 rural). Of 2,445 geriatric patient discharges, 40% of patients were from rural counties and were demographically similar to urban patients. Rural patients were more likely to present as a hospital transfer (15.4% vs 2.5%, p<0.01), receive care at a critical access hospital (24.1% vs 1.0%, p<0.01), receive care outside their home county (32.5% vs 12.8%, p<0.01), and be transferred to another hospital after surgery. Rural and urban patients underwent similar procedures, with similar length of stay, cost of index hospitalization, and mortality. CONCLUSION Rural geriatric patients in NH are more likely to receive care outside of their home county or be transferred to another hospital. Costs of care were similar but are likely underestimated for rural patients. There was no difference in unadjusted mortality. Further investigation is merited to determine the reasons for hospital transfer in the geriatric EGS population to evaluate which patients may benefit most from remaining close to home versus transferring to other facilities.