Surgical Hospital Closures Disproportionately Hit Poor And Socially Vulnerable Communities

A caller nationalist study reveals that hospitals providing surgical attraction person closed astatine a importantly higher complaint than caller ones person opened, pinch closures disproportionately concentrated successful communities pinch precocious levels of poorness and societal vulnerability. The study highlights a increasing disparity successful entree to surgical care. 

The investigation will beryllium presented astatine nan American College of Surgeons (ACS) Clinical Congress 2025 successful Chicago, October 4-7. 

Researchers utilized American Hospital Association information to way hospitals performing astatine slightest 100 operations per twelvemonth successful 2010 and 2020. Between infirmary openings and closures, they recovered a nett alteration of 298 surgical hospitals nationwide. The study authors past utilized nan Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) to comparison nan socioeconomic characteristics of areas pinch infirmary closures versus those pinch unchangeable aliases caller hospitals. 

We were amazed by conscionable really large of a number it was. It is beautiful startling to spot specified a drastic driblet without capable replacement volume, and it's concerning for diligent entree to care." 

Jesse E. Passman, MD, MPH, MSHP, lead author, wide room resident astatine nan Hospital of nan University of Pennsylvania, Philadelphia, Pennsylvania

Key findings  

• Net nonaccomplishment of access: The number of geographic areas wrong a 15-minute thrust of a surgical infirmary decreased by 6.2%, and nan areas wrong a 30-minute thrust decreased by 3.7%. 

• Targeted closures: Newly closed hospitals were disproportionately located successful census tracts pinch little median incomes and higher societal vulnerability scores than areas pinch hospitals that opened aliases remained active. These areas were much than doubly arsenic apt to beryllium highly socially vulnerable. 

• Systemic strain: Study authors pass that closures create a "huge influx of patients to surrounding hospitals, straining nan emergency departments and surgical departments." 

"One of nan hidden things that gets mislaid successful nan shuffle is diligent records," said elder writer Heather Wachtel, MD, MTR, FACS, an subordinate professor of room astatine nan University of Pennsylvania. "When a infirmary closes, patients who had their attraction location whitethorn suffer entree to their wellness attraction records. Having that accusation is basal to their ongoing wellness care." 

The reasons for closure, while not straight studied, are apt economic, related to challenges successful sustaining smaller hospitals and safety-net institutions that service a precocious proportionality of patients connected authorities insurance, authors note. 

Impacts for patients and wellness systems 

The study underscores respective captious consequences of infirmary closures: 

• Loss of aesculapian history: Patients tin permanently suffer entree to their aesculapian records, starring to costly and vulnerable duplicative testing, re-establishment of aesculapian history, and a deficiency of important wellness accusation for caller providers. 

• Strain connected surrounding systems: Remaining hospitals must sorb a abrupt influx of caller patients without established histories, stretching resources thin. 

• Patients whitethorn forgo care: The accrued load of recreation and uncovering caller providers tin origin immoderate patients to hold aliases wholly debar seeking basal aesculapian aliases surgical care, allowing conditions to worsen. 

"For each 1 of these patients that really shows up to our hospitals, I'm judge that there's a number of patients that don't," Dr. Passman said. "These conditions that could beryllium handled and perchance cured surgically are now festering and becoming chronic problems." 

Co-authors are Jeffrey L. Roberson, MD, MBA; Sara P. Ginzberg, MD, MSHP; Jasmine Hwang, MD, MS; Gracia M. Vargas, MD; Rachel R. Kelz, MD, MSCE, MBA, FACS; Giorgos C. Karakousis, MD, FACS; and Vicky W. Tam, MA.