Preliminary comparison of surgical site infection following colectomy at rural and urban hospitals

Author(s):
McKenzie White; Ayako Sekiya; Brooke Patterson; Jeffrey Chipman

Background:

There is tension between treating rural surgical patients in rural hospitals (RH) and transferring them to high-capacity urban hospitals (UH). Rural surgical patients face competing priorities of specialty care in an UH versus remaining close to home.

Hypothesis:

We hypothesized that among patients undergoing colectomy – an operation performed by general and colorectal surgeons – there would be no difference in surgical site infections (SSI) between patients cared for in RH and UH in Minnesota.

Methods:

Using a single institution dataset encompassing four RH and seven UH within a single hospital system in Minnesota (Jan 2011 – Sept 2023), we compared SSI between adult patients undergoing colectomy at RH and UH. Indications for colectomy are listed in Table 2 stratified by treatment hospital type. SSI occurrence was compared between RH and UH using fisher’s exact test. Additional outcomes were compared across RH and UH using varying statistical tests.

Results:

Patient populations were similar between RH and UH with older patients in RH (p<0.001), and more diverse patient population in UH (p<0.001) (Table 1). The proportion of colectomies performed for diverticulitis and diverticulosis was similar between RH and UH, while the proportion of colectomies performed for Crohn’s disease, ulcerative colitis, and colon cancer was higher at UH than RH (Table 2). Despite this, the incidence of SSI was similar between RH and UH (p=1.0) (Table 1).

Conclusions:

For patients undergoing colectomy, there was no statistically significant difference in rates of SSI between RH and UH. Indications for colectomy may vary by treating hospital type and may impact rate of SSI. Our study is limited by small numbers of RH patients. Further research is needed to describe the interplay of patient selection, treating hospital type, and SSI.