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

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.