The Effect of Travel Distance on Outcomes for Hip Resurfacing Arthroplasty at a High-Volume Center

Abstract

Background: Patients are increasingly traveling greater distances to receive care at high-volume centers. The effect of travel distance on patient-reported outcomes after hip resurfacing arthroplasty has not been described. Methods: Patients undergoing HRA by a single surgeon from January 2007 to April 2018 with minimum 2-year follow-up were reviewed retrospectively. Five hundred ninety-nine patients were identified and divided into 2 cohorts: home-to-hospital distance >100 miles and 100 miles from our institution. Preoperative and 2-year postoperative patient-reported outcome measures (PROMs) were assessed, including the modified Harris Hip Score and Hip disability and Osteoarthritis Outcome Score. The minimal clinically important difference (MCID) for each PROM was calculated using the distributionbased method. Chi-square tests were used for univariate comparison. Poisson regressions controlling for demographic variables were performed to determine the effect of travel distance on whether patients achieved the MCID. Multivariate linear regressions were used to determine association between distance and improvement in PROMs. Results: A total of 599 patients met criteria for inclusion. There were 113 (18.9%) with a home-to-hospital distance >100 miles and 486 (81.1%) with distance 100 miles. Age was the only demographic factor different between these groups (mean: 1.1-year difference, P < .001). There were no significant differences in reaching the MCID on any PROM between these groups. Multivariate linear regressions revealed no associations between travel distance and improvement in PROMs. Conclusions: Travel distance to a high-volume center did not affect 2-year patient-reported outcomes or rate of achieving the MCID in patients undergoing hip resurfacing arthroplasty.

Does Hypothetical Centralization of Revision THA and TKA Exacerbate Existing Geographic or Demographic Disparities in Access to Care by Increased Patient Travel Distances or Times? A Large-database Study

“…In contrast, Medicare's COE program for bariatric surgery did not affect access to care for nonwhite or rural patients, despite increased travel distances relative to non-Medicare patients, suggesting that each centralization program needs to be evaluated individually for its effects on different demographic populations [25]. One concern with increased travel distances might be an association with increasing complication/readmission rates; however, prior studies have not found a link between travel distance and complications in primary TJA [34,44]. Additionally, increased travel times impose a cost on patients, and for primary TJA, patients were willing to pay an extra USD 11.45 out of pocket to avoid traveling per mile for arthroplasty care, which means patient preferences will need to be further evaluated [42].…”

Evaluating Distance Bias in Chronic Rhinosinusitis Outcomes

“…These findings may be representative of patient factors (eg, severity of disease limiting ability to travel long distances for care) or may be associated with the volume or resources of treating facilities (eg, travel needed to reach high-volume, high-quality centers). In contrast to these reports, yet in alignment with findings from this study, several investigations exploring elective orthopedic procedures reported no difference in outcomes according to distance traveled to a tertiary care center . Although it can be hypothesized that patients traveling longer distances may be more committed to their health or have the ability to travel for medical care, and their corresponding habits and behaviors may be responsible for their improved outcomes, this phenomenon is not observed across the entirety of the disease spectrum.…”

“…In contrast to these reports, yet in alignment with findings from this study, several investigations exploring elective orthopedic procedures reported no difference in outcomes according to distance traveled to a tertiary care center. [17][18][19] Although it can be hypothesized that patients traveling longer distances may be more committed to their health or have the ability to travel for medical care, and their corresponding habits and behaviors may be responsible for their improved outcomes, 10 this phenomenon is not observed across the entirety of the disease spectrum.…”

“…[11][12][13][14][15] Conversely, a systematic review concluded that, across a wide range of health care services, an association between traveling longer distances and worse outcomes may be present; however, definitive conclusions could not be made owing to variations in study design, selection of outcomes, and distance cutoffs. 16 Finally, recent investigations exploring elective orthopedic procedures reported no difference in outcomes according to distance traveled, [17][18][19] suggesting that distance bias is likely multifactorial and may be associated with the diseasespecific outcomes being investigated.…”