Surgical hospital closures disproportionately hit poor and socially vulnerable communities

A new national study reveals that hospitals providing surgical care have closed at a significantly higher rate than new ones have opened, with closures disproportionately concentrated in communities with high levels of poverty and social vulnerability. The study highlights a growing disparity in access to surgical care. 

The research will be presented at the American College of Surgeons (ACS) Clinical Congress 2025 in Chicago, October 4-7. 

Researchers used American Hospital Association data to track hospitals performing at least 100 operations per year in 2010 and 2020. Between hospital openings and closures, they found a net decrease of 298 surgical hospitals nationwide. The study authors then used the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) to compare the socioeconomic characteristics of areas with hospital closures versus those with stable or new hospitals. 

We were surprised by just how big of a number it was. It is pretty startling to see such a drastic drop without adequate replacement volume, and it's concerning for patient access to care." 

Jesse E. Passman, MD, MPH, MSHP, lead author, general surgery resident at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

Key findings  

• Net loss of access: The number of geographic areas within a 15-minute drive of a surgical hospital decreased by 6.2%, and the areas within a 30-minute drive decreased by 3.7%. 

• Targeted closures: Newly closed hospitals were disproportionately located in census tracts with lower median incomes and higher social vulnerability scores than areas with hospitals that opened or remained active. These areas were more than twice as likely to be highly socially vulnerable. 

• Systemic strain: Study authors warn that closures create a "huge influx of patients to surrounding hospitals, straining the emergency departments and surgical departments." 

"One of the hidden things that gets lost in the shuffle is patient records," said senior author Heather Wachtel, MD, MTR, FACS, an associate professor of surgery at the University of Pennsylvania. "When a hospital closes, patients who had their care there may lose access to their health care records. Having that information is essential to their ongoing health care." 

The reasons for closure, while not directly studied, are likely economic, related to challenges in sustaining smaller hospitals and safety-net institutions that serve a high proportion of patients on government insurance, authors note. 

Impacts for patients and health systems 

The study underscores several critical consequences of hospital closures: 

• Loss of medical history: Patients can permanently lose access to their medical records, leading to costly and dangerous duplicative testing, re-establishment of medical history, and a lack of crucial health information for new providers. 

• Strain on surrounding systems: Remaining hospitals must absorb a sudden influx of new patients without established histories, stretching resources thin. 

• Patients may forgo care: The increased burden of travel and finding new providers can cause some patients to delay or completely avoid seeking necessary medical or surgical care, allowing conditions to worsen. 

"For each one of these patients that actually shows up to our hospitals, I'm sure that there's a number of patients that don't," Dr. Passman said. "These conditions that could be handled and potentially cured surgically are now festering and becoming chronic problems." 

Co-authors are Jeffrey L. Roberson, MD, MBA; Sara P. Ginzberg, MD, MSHP; Jasmine Hwang, MD, MS; Gracia M. Vargas, MD; Rachel R. Kelz, MD, MSCE, MBA, FACS; Giorgos C. Karakousis, MD, FACS; and Vicky W. Tam, MA.