Does travel distance influence length of stay in elective pancreatic surgery?

Jackson, Katharine L.; Glasgow, Robert E.; Mone, Mary C.; Sheng, Xiaoming; Mulvihill, Sean J.; Scaife, Courtney L.

doi:10.1111/hpb.12180

Cited by 28 publications

(14 citation statements)

References 14 publications

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“…19 Likewise, two studies by Jackson et al demonstrated an effect of distance traveled on length of stay for elective colorectal and pancreatic surgery. 20,21 These studies differed from ours in that the distances traveled in our study were much less (longest average distance 25 miles compared with an average distance over 200 miles). [19][20][21] Within the distances traveled in our study, a concentrated specialized care model is cost effective and does not negatively affect outcomes, although it may be inconvenient and incur increased personal costs for patients.…”

Section: Discussioncontrasting

confidence: 71%

Travel Burden and the Direct Medical Costs of Urologic Surgery

Olson

Gore

Daratha

et al. 2016

JHEOR

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Background: Increased surgical volume is associated with better patient outcomes and shorter lengths of hospitalization. As a consequence, traveling to receive care from a high volume provider may be associated with better outcomes. However, travel may also be associated with a decision by the healthcare provider to increase the length of stay due to a decreased ability to return to the primary hospital should complications arise. Thus, research is needed to understand the relationship between the distance a patient must travel and their outcomes following urologic surgery.Objective: The purpose of this study was to determine whether the distance a patient travels to receive urologic surgery is associated with their length of hospital stay and direct medical hospitalization costs. Methods:This was a retrospective observational cohort study of 12 106 patients over 50 years of age undergoing transurethral resection of the prostate (TURP), radical prostatectomy (RP) or radical cystectomy (RC) in Washington State hospitals between 2009 and 2013. Distance traveled was determined by calculating the linear distance between zip code centroids of patient residence and the hospital performing their procedure. Patients were sorted into four groups classified by distance traveled (≤5 miles, 6-20 miles, 21-50 miles and ≥51 miles) and cost calculated using a charges-to-reimbursement ratio for each hospital. Statistical significance was determined using a Kruskal-Wallis test.Results: Patients traveling greater distances had significantly lower median medical costs compared with patients who lived closer to the hospitals where they underwent TURP and RP (TURP: ≤5 miles, $6243 and ≥51 miles, $5105, p≤0.001; RP: ≤5 miles, $12 407 and ≥51 miles, $11 882, p≤0.001), whereas there was no significant difference for patients undergoing RC (≤5 miles, $27 554 and ≥51 miles, $26 761, p=0.17). Likewise, patients traveling greater distances had significantly lower median lengths of hospitalization for TURP and RP (TURP: p≤0.001, RP: p≤0.001), while there was no difference for RC (p=0.50). Conclusions:Patient travel burden does appear to play a role in cost and length of hospital stay for select urologic procedures with variable levels of morbidity and recovery time. Although these findings are statistically significant, the magnitude of the effect is small.

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Section: Discussioncontrasting

confidence: 71%

Travel Burden and the Direct Medical Costs of Urologic Surgery

Olson

Gore

Daratha

et al. 2016

JHEOR

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“…The author speculated the most likely reasons to be concerns about travel time, pain control, complications, availability of transportation, local weather and road conditions, and the time needed to organize multiple services should the patient be geographically isolated. 20 These findings warrant additional examination into patient and provider perceptions of traveling long distances to receive complex cancer care. These results also indicate that increased travel distance can have a different effect in different populations.…”

Section: Discussionmentioning

confidence: 99%

Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?

Jindal¹,

Zheng

Quadri

et al. 2017

Journal of the American College of Surgeons

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BACKGROUND Centralization of complex surgical care has led patients to travel longer distances. Emerging evidence suggested a negative association between increased travel distance and mortality after pancreatectomy. However, the reason for this association remains largely unknown. We sought to unravel the relationships among travel distance, receiving pancreatectomy at high-volume hospitals, delayed surgery, and operative outcomes. STUDY DESIGN We identified 44,476 patients who underwent pancreatectomy for neoplasms between 2004 and 2013 at the reporting facility from the National Cancer Database. Multivariable analyses were performed to examine the independent relationships between increments in travel distance mortality (30-day and long-term survival) after adjusting for patient demographics, comorbidity, cancer stage, and time trend. We then examined how additional adjustment of procedure volume affected this relationship overall and among rural patients. RESULTS Median travel distance to undergo pancreatectomy increased from 16.5 to 18.7 miles (p for trend < 0.001). Although longer travel distance was associated with delayed pancreatectomy, it was also related to higher odds of receiving pancreatectomy at a high-volume hospital and lower postoperative mortality. In multivariable analysis, difference in mortality among patients with varying travel distance was attenuated by adjustment for procedure volume. However, longest travel distance was still associated with a 77% lower 30-day mortality rate than shortest travel among rural patients, even when accounting for procedure volume. CONCLUSIONS Our large national study found that the beneficial effect of longer travel distance on mortality after pancreatectomy is mainly attributable to increase in procedure volume. However, it can have additional benefits on rural patients that are not explained by volume. Distance can represent a surrogate for rural populations.

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“…Distance bias, the supposition that patients who travel farther to receive medical care experience better outcomes, has been investigated in medical populations, but few studies have been conducted exploring this concept in patients undergoing surgery. 3,4 In the studies exploring the influence of distance on surgical readmissions, 3,[5][6][7][8] the evidence is mixed and techniques to calculate distance vary. Even less attention has been given to the unique challenges that are faced by centers that care for patients residing in rural areas.…”

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confidence: 99%

Travel Time Influences Readmission Risk: Geospatial Mapping of Surgical Readmissions

Turrentine¹,

Buckley²,

Sohn

et al. 2017

The American Surgeon™

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The University of Virginia (UVA) has recently become an Accountable Care Organization (ACO), intensifying efforts to provide better care for individuals. UVA's ACO population resides across the entire Commonwealth, with a large percentage of patients living in rural areas. To provide better health for this population, the central tenet of the ACO mission, we identified geographic risk factors influencing hospital readmission. We analyzed the relationship between the distance of patients’ residence to the nearest hospital and 30-day readmission in general surgery patients. A retrospective chart review using January 1, 2011 through October 31, 2013 American College of Surgeons National Surgical Quality Improvement Program data for general surgery procedures was conducted. ArcGIS mapped street addresses provided graphical representation of distance between surgical population and the nearest hospital. We analyzed the impact on readmission, of time traveled, insurance status, and median household income. Each increase of 10 minutes in travel time from the patient's residence to the nearest hospital, not just UVA, was associated with a 9 per cent increase in the probability of readmission after adjusting for patient characteristics, preoperative comorbidities, laboratory values, and postoperative complications before or after discharge (odds ratio = 1.09; 95% confidence interval = 1.01–1.17; P = 0.019). Unlike urban hospitals, those serving rural populations may be at particular risk of postsurgical readmissions. Patients living furthest from a hospital facility are most at risk for readmission after a general surgery procedure. This vulnerable population may benefit most from comprehensive discharge planning.

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Does travel distance influence length of stay in elective pancreatic surgery?

Abstract: Increased travel distance from a patient's home to the hospital was independently associated with an increase in LoS. If LoS is a reportable quality measure in pancreatic surgery, travel distance should be considered in risk adjustments.

Cited by 28 publications

References 14 publications

Travel Burden and the Direct Medical Costs of Urologic Surgery

Travel Burden and the Direct Medical Costs of Urologic Surgery

Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?

Travel Time Influences Readmission Risk: Geospatial Mapping of Surgical Readmissions

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