Background: Acromegaly is a rare disease caused by a growth hormone-secreting pituitary adenoma which results in potentially debilitating skeletal, cardiac and gastrointestinal disease. Surgical resection can be curative, but in Southern Alberta, skull base surgeons and multi-disciplinary pituitary teams work at a single centre, raising the question of whether rurally-dwelling patients experience worse outcomes. We aim to characterize post-surgical remission rates by living location in acromegaly patients at our institution. Methods: A retrospective chart review supplemented a single surgeon database of patients with acromegaly treated at our centre (February 2011-April 2022) with demographic, endocrinological, and surgical variables. Statistical analysis was performed using Stata Version 17. Results: Our cohort included 47 cases of acromegaly (53% male), all treated with endoscopic transsphenoidal surgery. The average age at first operation was 46.7 years (20-69 years), 77% were macroadenomas, and the average adenoma size at initial MRI was 16mm. 54.55% of the urban cohort achieved immediate post-surgical remission, versus 28.57% of the rural cohort (OR:3.0(95%CI:0.67,15.51)). Conclusions: The characteristics of our cohort agree with the literature. The odds of immediate post-surgical remission in urban-dwelling patients was 3.0 times that of rurally-dwelling patients. Our results failed to meet statistical significance likely due to lack of power secondary to sample size.