Work

Bypass of Local Surgical Care in North Carolina: Patient-Directed Care Destination and Utilization

Year: 2026

Type: article

Abstract: BackgroundAlthough frequent, patient bypass of local surgical care (bypass) remains understudied. No prior work has evaluated the association between bypass and local surgeon workforce density.MethodsThis is a retrospective cohort study of North Carolina patient bypass (receiving care at a hospital ≥ 10 miles farther from the nearest surgery-capable hospital) from 2016 to 2019 for urgent/emergent surgery. The association between bypass and clinical, sociodemographic, and NSH characteristics was estimated using logistic regression.Results23.7% of patients (n = 9864) bypassed local surgical care. These patients traveled further for care (median miles 25.8 vs 7.4). Living in counties with the lowest general surgeon workforce density (aOR: 1.58, 95% CI: 1.16, 2.16) and second lowest workforce density (aOR: 1.55, 95% CI: 1.26, 1.90) was associated with bypass.DiscussionApproximately 25% of patients undergoing urgent/emergent general surgeries bypassed their nearest surgical care. Patients in counties with lower workforce density were more likely to bypass the nearest surgical hospital.

Source: The American Surgeon

DOI: 10.1177/00031348261429424

Authors: Mustafa Abid, Tyler Malone, Mark Holmes, Anthony Charles

Institutions: University of North Carolina at Chapel Hill, University of Vermont

Language: English

Topic: Healthcare Policy and Management

Subfield: Economics and Econometrics

Field: Economics, Econometrics and Finance

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,150