A new retrospective study in the Journal of the American College of Surgeons offers one of the first detailed looks at how an urban hospital closure reshapes surgical care at the facilities left standing nearby, including who absorbs the extra caseload, when those cases show up, and how they’re paid for.
Researchers from the Division of Trauma and Surgical Critical Care at Brown University and Rhode Island Hospital tracked essential surgical volume at two neighboring hospitals before and after a 294-bed urban hospital in their city closed on Jan. 1, 2018. The study was published ahead of print and presented at the 105th Annual Meeting of the New England Surgical Society in September 2024.
Here are 10 things to know.
1. Researchers compared surgical activity from March 2015 through the January 2018 closure to activity from the closure through January 2024 at two hospitals in the same health system located about four miles from the closed facility: a neighboring community hospital and a state trauma/tertiary center. Both are teaching hospitals staffed by a dedicated acute care surgery service throughout the study period.
2. Rather than track every case, the study zeroed in on laparoscopic cholecystectomy, laparoscopic appendectomy, and incision and drainage, which are high-volume, time-sensitive procedures that acute care surgery teams typically absorb without dedicated OR block time, making them a sensitive marker of system strain.
3. Total operative volume rose 2.9% at the community hospital and fell 3.5% at the trauma center after closure, a statistically significant divergence that suggests redistribution rather than uniform system-wide growth.
4. Essential case volume climbed 20.2% at the community hospital while dropping 11.6% at the trauma center, pointing to an uneven burden on acute care surgery capacity between two hospitals in the same system.
5. Annual holiday and weekend caseloads rose 15.8% at the community hospital and 10.3% at the trauma center. Patients from the ZIP codes closest to the closed hospital accounted disproportionately for that off-hours growth.
6. The community hospital saw a 15.5% rise in the mean annual number of essential operations covered by public insurance alongside a 24.6% drop in privately insured essential cases. The trauma center’s privately insured essential case volume fell 76.9%.
7. Patients from the closed hospital’s old service area drove the public-insurance shift. Among the three ZIP codes closest to the closed hospital, essential operations covered by public insurance rose 28.7% at the community hospital and 11.4% at the trauma center, both larger increases than seen among patients from other nearby ZIP codes. Patients from those closest ZIP codes were significantly more likely to carry public insurance both before and after the closure.
8. After adjusting for pre-existing trends using an interrupted time series analysis, researchers did not find a statistically significant immediate jump or change in slope in essential operation volume at either hospital. Procedure-level analysis did show a significant immediate increase in laparoscopic cholecystectomy at the community hospital and a significant declining trend in laparoscopic appendectomy at the trauma center. The authors note the raw redistribution pattern may still carry real operational implications even where the adjusted trend fell short of significance.
9. ZIP codes closest to the closed hospital didn’t differ significantly from other nearby ZIP codes in age, median household income or uninsured rate. They did have a significantly lower share of white residents, raising equity considerations about who bears the effects of urban hospital closures.
10. Because emergency surgical services often lack dedicated operating room time and skew toward lower-reimbursement payers, the authors argue that reinforcing acute care surgery models, rather than assuming higher-volume centers will naturally absorb demand more efficiently, may be one of the most effective ways to protect timely surgical access after a nearby closure.
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