• Samir K Gadepalli, Harold J Leraas, Katherine T Flynn-O'Brien, Kyle J Van Arendonk, Matt Hall, Elisabeth T Tracy, Robert L Ricca, Adam B Goldin, and Peter F Ehrlich.
• Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI.
• Ann. Surg. 2023 Oct 1; 278 (4): 530537530-537.

ObjectiveTo describe the changes to routine pediatric surgical care over the past 2 decades for children living in urban and rural environments.BackgroundA knowledge gaps exists regarding trends in the location where routine pediatric surgical care is provided to children from urban and rural environments over time.MethodsChildren (age 0-18) undergoing 7 common surgeries were identified using State Inpatient Databases (SID, 2002-2017). Rural-Urban Commuting Area codes were used to classify patient and hospital zip codes. Multivariable regression models for distance traveled >60 miles and transfer status were used to compare rural and urban populations, adjusting for year, age, sex, race, and insurance status.ResultsAmong 143,467 children, 13% lived in rural zip codes. The distance traveled for care increased for both rural and urban children for all procedures but significantly more for the rural cohort (eg, 102% vs 30%, P <0.001, cholecystectomy). Transfers also increased for rural children (eg, transfers for appendectomy increased from 1% in 2002 to 23% in 2017, P <0.001). Factors associated with the need to travel >60 miles included year [adjusted odds ratio (aOR)=2.18, 95% CI: 1.94-2.46: 2017 vs 2002], rural residence (aOR=6.55, 95% CI: 6.11-7.01), age less than 5 years (aOR=2.17, 95% CI: 1.92-2.46), and Medicaid insurance (aOR=1.35, 95% CI: 1.26-1.45). Factors associated with transfer included year (aOR=5.77, 95% CI: 5.26-6.33: 2017 vs 2002), rural residence (aOR=1.47, 95% CI: 1.39-1.56), age less than 10 years (aOR=2.34, 95% CI: 2.15-2.54), and Medicaid insurance (aOR=1.49, 95% CI: 1.42-1.46).ConclusionRural children, younger age, and those on Medicaid disproportionately traveled greater distances and were more frequently transferred for common pediatric surgical procedures.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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