• Nazli Bahtigur, Ragavi Jeyamohan, Mohammad Hamiduzzaman, and Arron S Veltre.
• Department of Rural Health, College of Health Medicine & Wellbeing, the University of Newcastle, Callaghan, Australia.
• Postgrad Med. 2022 Nov 1; 134 (8): 718-731.

IntroductionStudies regarding patients who have underwent colectomy reported contradictory post-surgical complications based on their living areas. Due to the conflicting data surrounding whether rural or urban hospitals have lower postoperative complication rates, we have performed a systematic review and meta-analysis with the aim of understanding and assessing the evidence that has already been found.MethodsThe online databases PubMed, MEDLINE, EMBASE, SCOPUS, and CINAHL were searched for our literature review. We included papers with data on the postoperative complication rates for patients who had undergone colectomies. The patients were stratified based on the location status of the hospital, i.e. rural or urban. Data analysis was performed in Cochrane's Review Manager 5.41 software.ResultsA total of 921 studies were identified in the initial search; the inclusion and exclusion criteria refined the search results in 11 studies for review. The primary outcomes analyzed were mortality rate, length of stay and total complication rate. This review found that rural hospitals had either equal or lower inpatient postoperative mortality rates in comparison to urban hospitals for patients who had undergone colectomies. However, rural hospitals had a longer length of stay (mean length of stay in rural hospitals was 6.7 days and in urban hospitals was 4.9 days). It is important to note that the Australian hospitals had a mean length of stay of 13.5 days, which was almost double that of rural hospitals in America. The unadjusted rate of total complication was 26.51% in rural hospitals.ConclusionsRural hospitals overall have equivalent postoperative complication rates to urban hospitals and can provide sufficient postoperative patient care.

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