{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T22:49:39Z","timestamp":1793141379583,"version":"4.5.0"},"reference-count":29,"publisher":"American Academy of Pediatrics (AAP)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Disparities in pediatric health outcomes are widespread. It is unclear whether rurality negatively impacts outcomes of infants with surgical congenital diseases. This study compared outcomes of rural versus urban infants requiring complex surgical care at children\u2019s hospitals in the United States.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Rural and urban infants (aged &amp;lt;1 year) receiving surgical care at children\u2019s hospitals from 2016 to 2019 for esophageal atresia, gastroschisis, Hirschsprung\u2019s disease, anorectal malformation, and congenital diaphragmatic hernia were compared over a 1-year postoperative period using the Pediatric Health Information System. Generalized linear mixed effects models compared outcomes of rural and urban infants.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Among 5732 infants, 20.2% lived in rural areas. Rural infants were more frequently white, lived farther from the hospital, and lived in areas with lower median household income compared with urban infants (all P &amp;lt; .001). Rural infants with anorectal malformation and gastroschisis had lower adjusted hospital days over 1 year; rural infants with esophageal atresia had higher adjusted odds of 30-day hospital readmission. Adjusted mortality, hospital days, and readmissions were otherwise similar between the 2 groups. Outcomes remained similar when comparing urban infants to rural infant subgroups with the longest hospital travel distance (\u226560 miles) and lowest median household income (&amp;lt;$35\u2009000).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Despite longer travel distances and lower financial resources, rural infants with congenital anomalies have similar postoperative outcomes to urban infants when treated at children\u2019s hospitals. Future work is needed to examine outcomes for infants treated outside children\u2019s hospitals and to determine whether efforts are necessary to increase access to children\u2019s hospitals.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/hpeds.2023-007227","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T08:14:35Z","timestamp":1689840875000},"page":"733-743","source":"Crossref","is-referenced-by-count":7,"title":["Association of Rural Residence With Surgical Outcomes Among Infants at US Children\u2019s Hospitals"],"prefix":"10.1542","volume":"13","author":[{"given":"Christina","family":"Georgeades","sequence":"first","affiliation":[{"name":"aDepartment of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Vacek","sequence":"additional","affiliation":[{"name":"bDepartment of Surgery, University of Louisville, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cary","family":"Thurm","sequence":"additional","affiliation":[{"name":"cChildren\u2019s Hospital Association, Lenexa, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matt","family":"Hall","sequence":"additional","affiliation":[{"name":"cChildren\u2019s Hospital Association, Lenexa, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn","family":"Rangel","sequence":"additional","affiliation":[{"name":"dDepartment of Surgery, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Minneci","sequence":"additional","affiliation":[{"name":"eCenter for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children\u2019s Hospital, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Oldham","sequence":"additional","affiliation":[{"name":"aDepartment of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle J.","family":"Van Arendonk","sequence":"additional","affiliation":[{"name":"aDepartment of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2023,7,20]]},"reference":[{"issue":"12","key":"2023112714084590800_b1","doi-asserted-by":"crossref","first-page":"2566","DOI":"10.1016\/j.jpedsurg.2020.08.001","article-title":"The Right Child\/Right Surgeon initiative: a position statement on pediatric surgical training, subspecialization, and continuous certification from the American Pediatric Surgical Association","volume":"55","author":"Alaish","year":"2020","journal-title":"J Pediatr Surg"},{"issue":"6","key":"2023112714084590800_b2","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1177\/000313481708300634","article-title":"Workforce issues in pediatric surgery","volume":"83","author":"Nakayama","year":"2017","journal-title":"Am Surg"},{"issue":"6","key":"2023112714084590800_b3","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1097\/SLA.0000000000001666","article-title":"Regionalization of pediatric surgery: trends already underway","volume":"263","author":"Salazar","year":"2016","journal-title":"Ann Surg"},{"issue":"2","key":"2023112714084590800_b4","first-page":"173","article-title":"Can regionalization decrease the number of deaths for children who undergo cardiac surgery? 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