{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:59:13Z","timestamp":1790650753901,"version":"4.1.0"},"reference-count":22,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Approximately 20% of the U.S. population resides in rural areas where health care access is limited by physician shortages. This presents a disparity in emergency general surgery where timely intervention is essential. This study aims to evaluate the impact of rurality on outcomes of emergency general surgery patients transferred to a metropolitan center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective single-center cohort study of 1189 patients who underwent non-traumatic emergent exploratory laparotomies. Patient rurality was determined by Rural-Urban Commuting Area (RUCA) codes which categorize patients as metropolitan, micropolitan, small town, or rural. The primary outcome was in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Rural (n = 369) and small-town (n = 135) patients had similar preoperative comorbidities, Physiological Emergency Surgery Acuity Scores (PESAS), utilization of damage control laparotomies, ICU metrics, and outcomes compared to those that presented to a metropolitan center (n = 508). In contrast, micropolitan (n = 177) patients had higher PESAS scores (5 vs 3,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001) and underwent more damage control laparotomies (62% vs 40%\u201349%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001) with higher use of intraoperative vasopressors (57% vs 37%\u201339%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) and higher overall mortality (23% vs 13%\u201315%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.027).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Our findings suggest that a mature and centralized transfer system promotes equity of outcomes between rural and metropolitan emergency general surgery patients. Micropolitan patients were more acuity ill than patients of other degrees of rurality, which suggests that low acuity micropolitan patients were more likely to be managed within their own communities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348251378896","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T09:46:18Z","timestamp":1758102378000},"page":"15-21","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Emergency General Surgery Outcomes for Rural Patients: A Comparative Analysis of Rural, Micropolitan, and Metropolitan Populations"],"prefix":"10.1177","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9582-0922","authenticated-orcid":false,"given":"Anthony J.","family":"Duncan","sequence":"first","affiliation":[{"name":"University of North Dakota, School of Medicine & Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9436-562X","authenticated-orcid":false,"given":"Samuel J.","family":"Bloomsburg","sequence":"additional","affiliation":[{"name":"University of North Dakota, School of Medicine & Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9394-2483","authenticated-orcid":false,"given":"Wade","family":"Hopper","sequence":"additional","affiliation":[{"name":"University of North Dakota, School of Medicine & Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Sturdevant","sequence":"additional","affiliation":[{"name":"University of North Dakota, School of Medicine & Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mentor","family":"Ahmeti","sequence":"additional","affiliation":[{"name":"University of North Dakota, School of Medicine & Health Sciences"},{"name":"Sanford Medical Center Fargo"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"key":"e_1_3_3_2_2","volume-title":"Nation\u2019s Urban and Rural Populations Shift Following 2020 Census","author":"Bureau USC","year":"2024","unstructured":"Bureau USC. Nation\u2019s Urban and Rural Populations Shift Following 2020 Census. Census.gov; 2024. https:\/\/www.census.gov\/newsroom\/press-releases\/2022\/urban-rural-populations.html"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1992.03490130097037"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.161.5.737"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.06.020"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.disamonth.2012.08.005"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/ewjm.173.5.348"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.52232"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.22605\/RRH7822"},{"issue":"2","key":"e_1_3_3_10_2","first-page":"411","article-title":"Rural proofing for health: a commentary","volume":"5","author":"Swindlehurst HF","year":"2005","unstructured":"Swindlehurst HF, Deaville JA, Wynn-Jones J, Mitchinson KM. Rural proofing for health: a commentary. 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