CHICAGO - a surprising study of nearly 46 million patients said Medicare older residents in rural areas are more likely to have one of the nine common surgeries that people in the cities.
Back surgery, hip and knee replacement and removal of the prostate have been among the transactions more often rural Medicare patients, the study found. Emergency surgery and elective operations both were more frequent for residents of rural areas.
The results seem to challenge the idea that urban dwellers have better access to medical care, but experts say that the research raises more questions than it answers.
"When I saw first the result, I looked at and said perhaps that I got it back," said senior author Dr. Mark Francis, researcher at the Texas Tech University Health Sciences Center at El Paso. The study does not indicate where rural residents had surgery. It is likely that many had to travel some distance, which could be risky during urgent surgery is necessary.
The study did not report on how patients fared after their operations. Neither it said if the residents of rural areas had worse health overall that the inhabitants of the city, although some previous research suggested, this is true in General.
The authors say that their findings could mean that rural residents are more sick, if they have, treatment or more likely to delay the treatment of pain until they worsen and require surgery.
It is also possible residents of rural areas have less access to non-surgical treatments or consider as less desirable. But the real reason cannot be drawn from the study, which was an analysis of data on all patients to Medicare in 2006.
Although cases are five years old Francis said that the likely results of reflect current practice and noted that he had found similar trends, dating back to the 1990s. He said, it is unlikely that the recession had much impact because these patients are covered by health insurance.
Researchers used the ZIP codes and a system of classification of government areas on a scale of 10 points, with 1 being the most urban and 10 of the rural. They have compared rates of surgery for residents of 7 to 10 - rural - regions with most urban areas.
The study was published Monday in the Archives of surgery.
Francis said colleagues told him: "If you find a difference of 5 per cent, which would be a big difference to a view of public health policy." But the contrast between the two groups was great for all but one of operations - like abdominal aortic aneurysm.
Residents of rural areas were almost 20% more likely to have replacement heart valve and approximately 15 percent more likely to obtain replacements of the knee or hip or spine fusion surgery. Smaller, but still note differences were found for the surgery of the prostate, appendectomy, surgery to remove blockages of the neck artery and surgery to correct the broken hips.
A critique of Archives, said the study raises some difficult questions.
"We have been led to believe that patients in rural areas do not have appropriate access to the surgery." "Although this may be true for specific areas, it seems to be the case of the nation, as a whole" surgeon Massachusetts General Hospital, Dr. George Velmahos wrote.
Dr. Sam Finlayson, a Dartmouth Medical School surgeon and researcher, called the results provocative but said, "I do not think that this study can destroy all the evidence that there are pockets of problems related to access to surgical care throughout rural America".
Other research has suggested that there is a growing shortage of surgeons in rural America. But Keith Mueller, a specialist in rural health at the University of Iowa, said that the new study raises the "so what?" If the people lacking local access can get surgery elsewhere. Despite this, he said, it may be more appropriate to have more of these services locally.
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