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

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.

Figure 1

Flow chart of the exclusion criteria used to craft final list of hospitals capable of providing 24/7 access to emergency general surgery care

Figure 2.. Distribution of Emergency General Surgery Across the United States.

This map shows the distribution of EGS (2,811) hospitals in the continental US by state and county population density. Each dot represents a hospital reported by the Annual Survey of Hospitals by the American Hospital Association to be an “acute care hospital” providing “surgical services” with both an “emergency room” and at least one “operating room.” Maroon dots represent EGS hospitals (EGS hospital = hospital providing emergency general surgery care 24 hours daily)

Figure 3.. Access to Hospitals Providing Emergency General Surgery Care Based on Race and Ethnicity

Figure 3a. EGS Hospitals (2,811) Mapped Over US County Percent African American Population. Figure 3b. EGS Hospitals (2,811) Mapped Over US County Percent Hispanic Population (EGS hospital = hospital providing emergency general surgery care 24 hours daily)

Figure 4.. Access to Hospitals Providing Emergency General Surgery Care Based on Socioeconomic Characteristics.

Figure 4a. EGS Hospitals (2,811) Mapped Over US County Percent Uninsured Population. Figure 4b. EGS Hospitals (2,811) Mapped Over US County Percent Population Living less than 200% below Federal Poverty Level Figure 4c. EGS Hospitals (2,811) Mapped Over US County Percent of Adults >25 Years Old with at Least a Bachelor’s Degree. (EGS hospital = hospital providing emergency general surgery care 24 hours daily)