CHICAGO — When facing an urgent surgical need, such as appendicitis, patients sometimes choose to bypass their nearest hospital to find care further away that they think may be better. However, this choice may have unintended consequences including increased odds of disease progression, complications, and prolonged length of stay according to a new study published in the Journal of the American College of Surgeons (JACS).
Researchers analyzed data from Arizona, Iowa, North Carolina, Vermont, and Wisconsin. They selected these states to capture different types of rural landscapes — from metropolitan-adjacent to remote frontier areas — and varying levels of road connectivity.
“Bypassing your nearest hospital for emergency surgery is a high-stakes decision,” said Mustafa Abid, MD, MPH, senior author of the study, and surgery resident at The University of North Carolina at Chapel Hill. “Our findings suggest that while patients may be trying to get to the ‘right place’ for care immediately, the extra time spent traveling appears to come with a clinical cost, including more severe illness by the time they reach the operating room.”
Study Results
The study results of 22,902 patients across five states show that 11.3% traveled at least 10 miles past the nearest hospital where general surgery was performed. Compared to those who went to the closest facility, bypassing patients were more likely to be from rural areas. Bypassing was strongly associated with worse clinical outcomes:
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Increased Disease Severity: 22% higher odds of presenting with progressed disease (such as a burst appendix).
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Longer Hospitalization: 20% higher odds of a hospital stay over six days.
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Reduced Transfers: 48% lower odds of being transferred to another hospital after admission, suggesting patients often “right-size” their destination to avoid subsequent transfers.
“Patients are trying to make rational choices, often to avoid the potential delays and fragmentation of care that can come with being transferred between hospitals,” Dr. Abid said. “But bypassing the closest care means they are arriving sicker and facing more complications. We need to understand what’s driving these decisions and how we can better support patients in getting timely, effective care.”
Patients are looking to “right-size” care, but that choice may be out of their hands depending on their use of emergency medical services. The authors note these findings are particularly timely as access to local surgical care evolves.
“As some communities lose local hospital services, more patients will be forced into longer travel for emergency care,” Dr. Abid said. “This research gives us a window into the potential clinical impact of that increased travel distance.”
A Path to Confidence in Local Surgical Care
Access to high-quality care is an important consideration for all patients. By achieving outside accreditation, such as that of the American College of Surgeons (ACS) Emergency General Surgery Verification Program (EGS-VP), hospitals in large and small communities can give patients the confidence to receive their care locally without risking the complications that come from increased travel distance to the hospital.
“This study shows patients are driving further than perhaps they need to, in order to get surgical care,” said Clifford Y. Ko, MD, MS, MSHS, FACS, Senior Vice President of the ACS Division of Research and Optimal Patient Care, who wasn’t involved with the study. “If one of the reasons is because of unknown or unrecognized surgical quality, the ACS Emergency General Surgery Verification Program provides hospitals with not only an evaluation of their care, but more importantly a roadmap to deliver consistently excellent, evidence-based care and a recognized designation that may help patients feel secure in choosing local and likely more timely intervention.”
Co-authors are Tyler Malone, PhD; Mark Holmes, PhD; and Anthony Charles, MD, MPH, FRCSEd, FACS.
This study is published as an article in press on the JACS website.
Citation: Mustafa A, Malone T, Holmes M, et al. Consequences of Patient-directed Bypass of Local Surgical Care: A Multi-state Analysis. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001751
