Study: Surgical hospital closures hit vulnerable communities hardest

Editor's Note

Hospitals that provide surgical care are closing faster than new ones are opening, deepening inequities in access to surgery for socioeconomically disadvantaged communities, American College of Surgeons October 3 reports. Closures not only disrupt care, but also deter many from seeking surgery altogether. Increased travel burdens and difficulty finding new providers can cause patients to delay or abandon care, making way for treatable conditions to progress into chronic disease.

Between 2010 and 2020, the US saw a net loss of 298 surgical hospitals, a 6.36% decline. Of 4,688 hospitals performing at least 100 surgical procedures annually in 2010, 784 closed by 2020 while only 486 opened. The closures were heavily concentrated in areas with high poverty and social vulnerability, the article reports. Using the CDC’s Social Vulnerability Index, researchers found hospitals that closed were more than twice as likely to be located in highly vulnerable census tracts compared with those that stayed open.

Lead author Jesse E. Passman, MD, MPH, MSHP, of the University of Pennsylvania, called the scale of loss “startling” and warned of growing disparities in access to surgical care. The study showed geographic areas within a 15-minute drive of a surgical hospital declined by 6.2%, while those within a 30-minute drive dropped by 3.7%, signaling expanding surgical “deserts.”

The consequences extend beyond geography. Per the article, closures force remaining hospitals to absorb displaced patients, straining emergency and surgical departments. Senior author Heather Wachtel, MD, MTR, FACS, noted patient medical records are often lost during closures, which can lead to duplicative testing, delayed diagnoses, and gaps in continuity of care.

Economic pressures likely play a key role. Although the study did not directly analyze causes, the authors pointed to the financial fragility of small and safety-net hospitals that rely heavily on government reimbursement. These institutions are disproportionately located in areas where residents face greater social and economic challenges.