{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T22:40:26Z","timestamp":1768344026200,"version":"3.49.0"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Hospital closures pose persistent concerns about health care access, yet the extent to which closures are associated with cancer surgical care and patient outcomes remains unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the association between undergoing colon or lung cancer surgery in hospitals that subsequently closed and postoperative and travel outcomes among Medicare beneficiaries.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study used Medicare administrative data from 2008 to 2019. A national sample of hospital closures was identified using the Provider of Service files from the Centers for Medicare &amp;amp; Medicaid Services. Closed cancer surgical hospitals were those performing at least 1 colon or lung cancer surgery in the period from 2008 to 2019 and that also stopped inpatient care in 2008 to 2019. Participants were Medicare fee-for-service beneficiaries who underwent colon or lung cancer surgery from 2008 to 2019. Analyses were conducted separately by cancer type. Data were analyzed from December 2023 through February 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Undergoing cancer surgery at hospitals that subsequently closed.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were postoperative outcomes, including 90-day mortality, 90-day complications, and length of stay. Secondary outcomes were travel measures, including distance to surgical hospital and distance to the nearest alternative surgical hospital. Logistic regression was used to analyze 90-day postoperative mortality and complications, and linear regression was used to analyze length of stay. Travel measures were analyzed descriptively.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The total sample was 558\u202f708 participants, with 360\u202f564 beneficiaries (64.5%) who underwent colon cancer surgery (median [IQR] age, 77 [71-83] years; 195\u202f862 [54.3%] female) and 198\u202f144 beneficiaries (35.5%) who underwent lung cancer surgery (median [IQR] age, 73 [69-78] years; 102\u202f418 [51.7%] female) from 2008 to 2019. Of those, 6018 beneficiaries (1.7%) who underwent colon cancer surgery and 1938 beneficiaries (1.0%) who underwent lung cancer surgery underwent those surgical procedures at hospitals that subsequently closed. Beneficiaries treated at hospitals that subsequently closed were more often dually eligible (colon: 1047 [17.4%] closing vs 37228 [10.5%] nonclosing; lung: 234 [12.1%] closing vs 14426 [7.4%] nonclosing) and Black, Hispanic, or other race (ie, American Indian or Alaska Native, Asian, other, and unknown) (colon: 1450 [24.1%] closing vs 53640 [15.1%] nonclosing; lung: 388 [20.0%] closing vs 22048 [11.2%] nonclosing), with urgent admission (colon: 2559 [42.5%] closing vs 123830 [34.9%] nonclosing; lung: 228 [11.8%] closing vs 13394 [6.8%] nonclosing) than those treated at hospitals that did not close. Most beneficiaries bypassed their nearest hospital, but the majority treated at their nearest hospital that subsequently closed (colon, 1967 beneficiaries [79.0%]; lung, 465 beneficiaries [90.6%]) had an alternative surgical hospital within a 15-minute driving distance. Undergoing surgery at hospitals that subsequently closed was significantly associated with higher likelihood of 90-day mortality for colon cancer (adjusted odds ratio [aOR] 1.11; 95% CI, 1.01-1.22) and 90-day complications for both cancer types (colon aOR, 1.10; 95% CI, 1.01-1.21; lung aOR, 1.43, 95% CI, 1.17-1.76). The odds ratio for 90-day mortality after lung cancer surgery was not statistically significant, 1.26 (95% CI, 0.96-1.64). Lengths of stay were similar for both cancers.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, undergoing colon and lung cancer surgery at hospitals that subsequently closed was associated with worse postoperative outcomes, but most beneficiaries treated at their nearest hospital had a nearby alternative hospital, suggesting that hospital closures may improve postoperative outcomes for cancer surgery, with minimal increase in travel burden, by directing patients to nearby, better-performing hospitals.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.53704","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T16:00:27Z","timestamp":1768320027000},"page":"e2553704","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes Among Medicare Beneficiaries After Cancer Surgery in Hospitals That Subsequently Closed"],"prefix":"10.1001","volume":"9","author":[{"given":"Min-Young","family":"Kim","sequence":"first","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas O.","family":"Staiger","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire"},{"name":"Department of Economics, Dartmouth College, Hanover, New Hampshire"},{"name":"National Bureau of Economic Research, Cambridge, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel A.","family":"Brooks","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire"},{"name":"Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire"},{"name":"Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qianfei","family":"Wang","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra L.","family":"Wong","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire"},{"name":"Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire"},{"name":"Emory School of Medicine, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna N. A.","family":"Tosteson","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire"},{"name":"Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire"},{"name":"Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"issue":"1","key":"zoi251433r3","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1111\/jrh.12128","article-title":"The rising rate of rural hospital closures.","volume":"32","author":"Kaufman","year":"2016","journal-title":"J Rural Health"},{"issue":"3","key":"zoi251433r4","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1111\/jrh.12187","article-title":"Predicting financial distress and closure in rural hospitals.","volume":"33","author":"Holmes","year":"2017","journal-title":"J Rural Health"},{"key":"zoi251433r5","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2024.1415033","article-title":"Drivers, adaptations, and public impacts of hospital closures: implications for policy.","volume":"12","author":"Saghafian","year":"2024","journal-title":"Front Public Health"},{"issue":"11","key":"zoi251433r7","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1002\/jhm.12973","article-title":"Causes and consequences of rural hospital closures.","volume":"17","author":"Chatterjee","year":"2022","journal-title":"J Hosp Med"},{"issue":"5","key":"zoi251433r11","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1111\/1475-6773.13988","article-title":"Changes in economic outcomes before and after rural hospital closures in the United States: a difference-in-differences?study.","volume":"57","author":"Chatterjee","year":"2022","journal-title":"Health Serv Res"},{"issue":"6","key":"zoi251433r12","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1097\/MLR.0000000000001711","article-title":"Rural hospital closures: effects on utilization and medical spending among commercially insured individuals.","volume":"60","author":"Andreyeva","year":"2022","journal-title":"Med Care"},{"issue":"2","key":"zoi251433r14","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1111\/j.1475-6773.2005.00497.x","article-title":"The effect of rural hospital closures on community economic health.","volume":"41","author":"Holmes","year":"2006","journal-title":"Health Serv Res"},{"issue":"5","key":"zoi251433r15","first-page":"409","article-title":"Cancer treatment and survivorship statistics, 2022.","volume":"72","author":"Miller","year":"2022","journal-title":"CA Cancer J Clin"},{"key":"zoi251433r16","doi-asserted-by":"crossref","first-page":"m4087","DOI":"10.1136\/bmj.m4087","article-title":"Mortality due to cancer treatment delay: systemic review and meta-analysis.","volume":"371","author":"Hanna","year":"2020","journal-title":"BMJ"},{"issue":"34","key":"zoi251433r17","doi-asserted-by":"crossref","first-page":"3234","DOI":"10.1200\/JCO.18.02035","article-title":"Centralization of high-risk cancer surgery within existing hospital systems.","volume":"37","author":"Sheetz","year":"2019","journal-title":"J Clin Oncol"},{"issue":"4","key":"zoi251433r18","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1245\/s10434-022-13029-3","article-title":"Impact of cancer care regionalization on patient volume.","volume":"30","author":"Contrera","year":"2023","journal-title":"Ann Surg Oncol"},{"issue":"2","key":"zoi251433r19","doi-asserted-by":"crossref","DOI":"10.1111\/jrh.12890","article-title":"Travel burden and bypassing closest site for surgical cancer treatment for urban and rural oncology patients.","volume":"41","author":"Onega","year":"2024","journal-title":"J Rural Health"},{"issue":"1","key":"zoi251433r20","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12942-016-0039-7","article-title":"Is the closest facility the one actually used? 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October 2023. Accessed November 24, 2025.https:\/\/www.nber.org\/system\/files\/working_papers\/w31789\/w31789.pdf","DOI":"10.3386\/w31789"},{"key":"zoi251433r26","unstructured":"US Department of Agriculture. Rural-urban commuting area codes. March 22, 2023. Accessed March 26, 2025. https:\/\/www.ers.usda.gov\/data-products\/rural-urban-commuting-area-codes.aspx"},{"key":"zoi251433r28","unstructured":"Agency for Healthcare Research and Quality. Elixhauser comorbidity software for ICD-9-CM healthcare cost and utilization project (HCUP). June 2017. Accessed October 15, 2024. https:\/\/hcup-us.ahrq.gov\/toolssoftware\/comorbidity\/comorbidity.jsp"},{"key":"zoi251433r29","unstructured":"Agency for Healthcare Research and Quality. Elixhauser comorbidity software refined for ICD-10-CM healthcare cost and utilization project (HCUP). February 2024. 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August 20, 2025. Accessed November 4, 2025. https:\/\/www.gao.gov\/products\/gao-25-106473"},{"key":"zoi251433r39","unstructured":"NBC New York Staff. Mount Sinai-Beth Israel hospital closes, emergency room shut down. April 9, 2025. Accessed November 25, 2025. https:\/\/www.nbcnewyork.com\/manhattan\/mount-sinai-beth-israel-hospital-closes-emergency-room-shut-down-east-village\/6218402\/"},{"key":"zoi251433r40","unstructured":"Arnold? J. Providence Hospital closes after 158 years | \u2018I think it will put a lot of people in jeopardy\u2019. WUSA9. May 1, 2019. Accessed November 25, 2025. https:\/\/www.wusa9.com\/article\/news\/i-think-it-will-put-a-lot-of-people-in-jeopardy-providence-hospital-closes-after-158-years\/65-9c9a17e2-92b5-4a35-bb23-bde122906ab7"},{"key":"zoi251433r44","unstructured":"The Leapfrog Group. Complex adult and pediatric surgery. 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