Rurality and cancer surgery in the United States

Abraham Markin, Elizabeth B. Habermann, Christopher J. Chow, Yanrong Zhu, Selwyn M. Vickers, Waddah B. Al-Refaie

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background: Rurality adversely impacts the continuum of cancer care. However, investigations of rural cancer surgery are notably absent. We examined patterns and outcomes of oncologic resections at rural US hospitals. Methods: We identified 928,370 hospital admissions in which 1 of 20 oncologic resections was performed using the 1998 to 2009 Nationwide Inpatient Sample. Logistic regression examined predictors of rurality and the adjusted likelihood of in-hospital mortality at rural and urban hospitals. Results: The fraction of procedures performed at rural hospitals decreased from 12% to 6%. Older age, non-Hispanic white race, and fewer comorbidities predicted rurality. Rural hospitals did not have worse mortality, however, rurality significantly augmented mortality among recipients of complex cancer surgery. Conclusions: Rural hospitals had comparable mortality overall, but delivered poorer outcomes for certain groups. Future research should explore these variations as cancer care is increasingly centralized.

Original languageEnglish (US)
Pages (from-to)569-573
Number of pages5
JournalAmerican journal of surgery
Issue number5
StatePublished - Nov 2012


  • Cancer treatment
  • Outcomes
  • Patterns of care
  • Rural health care
  • Surgical oncology

ASJC Scopus subject areas

  • Surgery


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