Impact of Nearby Hospital Closure on Surgical Services: A Retrospective Quasi-Experimental Study.

BACKGROUND: Hospital closures are increasing because of consolidation, acquisition, and rising operating costs, yet their effects on surgical workload redistribution within regional health systems remain poorly defined. We evaluated the impact of an urban hospital closure on operative volume, essential surgical procedures, payer mix, and timing of presentation at a neighboring community hospital (NCH) and a state trauma center (TC). STUDY DESIGN: A retrospective review compared surgical activity before (2015-2017) and after (2018-2024) closure of an urban hospital. Patient demographics, insurance status, operative volume, and presentation timing were analyzed at the NCH and TC. Essential operations were defined as laparoscopic cholecystectomy, laparoscopic appendectomy, and incision and drainage. Analyses were stratified by zip codes previously served by the closed hospital. RESULTS: Following hospital closure, total operative volume increased by 2.9% at the NCH and decreased by 3.5% at the TC. Essential operations increased by 20.2% at the NCH but decreased by 11.6% at the TC. Both hospitals experienced increases in holiday/weekend operations (NCH, 15.8%; TC, 10.3%). Patients from zip codes previously served by the closed hospital disproportionately contributed to growth in off-hours surgical care and were more likely to be publicly insured. Private insurance coverage did not differ before versus after closure at either hospital. CONCLUSIONS: Closure of an urban hospital was associated with redistribution of urgent surgical care toward neighboring hospitals, particularly increases in off-hours essential operations among publicly insured patients. These findings may inform operating room capacity planning, workforce allocation, and resource deployment across surgical systems serving vulnerable populations.