Rural centres do not have a higher prevalence of post-operative complications than urban centres: a retrospective analysis of a mortality audit

BACKGROUND: The trend towards centralization of surgical care from rural to high-volume centres is based on studies showing better outcomes for patients requiring complex surgical procedures. However, evidence that this also applies to less complex procedures is lacking. This study therefore aimed to determine whether there was a relationship between geographic location (rural versus urban) of surgical procedures of varying complexity and post-operative complications. METHODS: This was a retrospective cohort study examining all in-hospital deaths reported to the Australian and New Zealand Audit of Surgical Mortality (ANZASM) between 2009 and 2016. Multivariable logistic regression was used to ascertain interactive effects of location and complexity of surgical procedures on post-operative complications, adjusted for potential confounders. RESULTS: There was no interactive effect of hospital location and operation complexity on the occurrence of post-operative complications. Post-operative complications were reported in 2160 of 6963 (31%) patients who died post-surgery. Patients operated on in rural centres had lower risk profiles: younger, with lower American Society of Anesthesiologists grades and less likely to present with injury and circulatory diseases. Nonetheless, risk of post-operative complications did not differ between procedures performed in rural compared with urban hospitals. CONCLUSION: Results of this study suggest that a wide range of procedures may be safely performed in rural centres. Further prospective studies of unfiltered cohorts are warranted to validate these findings.