Changing Landscape of Routine Pediatric Surgery for Rural and Urban Children: A Report From the Child Health Evaluation of Surgical Services (CHESS) Group.
Ann Surg
; 278(4): 530-537, 2023 10 01.
Article
en En
| MEDLINE
| ID: mdl-37497661
ABSTRACT
OBJECTIVE:
To describe the changes to routine pediatric surgical care over the past 2 decades for children living in urban and rural environments.BACKGROUND:
A knowledge gaps exists regarding trends in the location where routine pediatric surgical care is provided to children from urban and rural environments over time.METHODS:
Children (age 0-18) undergoing 7 common surgeries were identified using State Inpatient Databases (SID, 2002-2017). Rural-Urban Commuting Area codes were used to classify patient and hospital zip codes. Multivariable regression models for distance traveled >60 miles and transfer status were used to compare rural and urban populations, adjusting for year, age, sex, race, and insurance status.RESULTS:
Among 143,467 children, 13% lived in rural zip codes. The distance traveled for care increased for both rural and urban children for all procedures but significantly more for the rural cohort (eg, 102% vs 30%, P <0.001, cholecystectomy). Transfers also increased for rural children (eg, transfers for appendectomy increased from 1% in 2002 to 23% in 2017, P <0.001). Factors associated with the need to travel >60 miles included year [adjusted odds ratio (aOR)=2.18, 95% CI 1.94-2.46 2017 vs 2002], rural residence (aOR=6.55, 95% CI 6.11-7.01), age less than 5 years (aOR=2.17, 95% CI 1.92-2.46), and Medicaid insurance (aOR=1.35, 95% CI 1.26-1.45). Factors associated with transfer included year (aOR=5.77, 95% CI 5.26-6.33 2017 vs 2002), rural residence (aOR=1.47, 95% CI 1.39-1.56), age less than 10 years (aOR=2.34, 95% CI 2.15-2.54), and Medicaid insurance (aOR=1.49, 95% CI 1.42-1.46).CONCLUSION:
Rural children, younger age, and those on Medicaid disproportionately traveled greater distances and were more frequently transferred for common pediatric surgical procedures.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Población Rural
/
Accesibilidad a los Servicios de Salud
Tipo de estudio:
Evaluation_studies
/
Prognostic_studies
Aspecto:
Determinantes_sociais_saude
Límite:
Adolescent
/
Child
/
Child, preschool
/
Humans
/
Infant
/
Newborn
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Ann Surg
Año:
2023
Tipo del documento:
Article