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Invited Critique
May 2011May 16, 2011

Surprise, Surprise!: More Surgery in Rural Areas Than in Cities: Comment on “Rural-Urban Differences in Surgical Procedures for Medicare Beneficiaries”

Author Affiliations

Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Surg. 2011;146(5):584. doi:10.1001/archsurg.2011.38

This excellent analysis of a massive sample of Medicare beneficiaries produces surprising results and generates hard questions. We have been led to believe that patients in rural areas lack appropriate access to surgery. Although this may be true for specific areas, it does not seem to be true for the nation as a whole according to Francis and colleagues. Medicare beneficiaries who live far from big centers have a significantly higher likelihood of receiving urgent (eg, appendectomy) and elective (eg, lumbar spine fusion) procedures. One is unsure whether these eye-opening findings should cause joy or distress.