Travel distance and regional access to cardiac valve surgery

Hawkins, Robert B.; Byler, Matthew R.; Fonner, Clifford E.; Krön, Irving L.; Yarboro, Leora T.; Speir, Alan M.; Quader, Mohammed; Ailawadi, Gorav; Mehaffey, J. Hunter

doi:10.1111/jocs.14199

Cited by 8 publications

(7 citation statements)

References 23 publications

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“…Specifically, analysis of the National Cancer Database by Massa et al revealed that, among patients with head and neck cancer, those living within 5 miles (8 km) of the treating facility had significantly worse long-term survival. Similarly, long-term survival has been shown to improve when patients travel longer distances for cardiac valve surgery . 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).…”

Section: Discussionsupporting

confidence: 56%

“…Similarly, long-term survival has been shown to improve when patients travel longer distances for cardiac valve surgery. 7,36 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, highquality 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.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating Distance Bias in Chronic Rhinosinusitis Outcomes

Gill

Beswick

Mace

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEThe distance traveled by patients for medical care is associated with patient outcomes (ie, distance bias) and is a limitation in outcomes research. However, to date, distance bias has not been examined in rhinologic studies.OBJECTIVE To evaluate the association of distance traveled by a cohort of patients with chronic rhinosinusitis with baseline disease severity and treatment outcomes. DESIGN, SETTING, AND PARTICIPANTSA total of 505 patients with chronic rhinosinusitis were prospectively enrolled in a multi-institutional, cross-sectional study in academic tertiary care centers between April 2011 and January 2020. Participants self-selected continued appropriate medical therapy or endoscopic sinus surgery. The 22-item Sinonasal Outcome Test (SNOT-22) and Medical Outcomes Study Short Form 6-D (SF-6D) health utility value scores were recorded at enrollment and follow-up. Data on the distances traveled by patients to the medical centers, based on residence zip codes, and medical comorbid conditions were collected.EXPOSURES Distance traveled by patient to obtain rhinologic care. and SF-6D scores. Scores for SNOT-22 range from 0 to 110; and for SF-6D, from 0.0 to 1.0. Higher SNOT-22 total scores indicate worse overall symptom severity. Higher SF-6D scores indicate better overall health utility; 1.0 represents perfect health and 0.0 represents death. MAIN OUTCOMES AND MEASURES RESULTSThe median age for the 505 participants was 56.0 years (IQR, 41.0-64.0 years), 261 were men (51.7%), 457 were White (90.5%), and 13 were Hispanic or Latino (2.6%). These categories were collected according to criteria described and required by the National Institutes of Health and therefore do not equal the entire cohort. Patients traveled a median distance of 31.6 miles (50.6 km) (IQR,). Baseline (r = 0.00; 95% CI, 0.00-0.18) and posttreatment (r = 0.01; 95% CI, -0.07 to 0.10) SNOT-22 scores, as well as baseline (r = -0.12; 95% CI, -0.21 to -0.04) and posttreatment (r = 0.07; 95% CI, -0.02 to 0.16) SF-6D scores, were not associated with distance. There was no clinically meaningful correlation between distance traveled and mean comorbidity burden. Nevertheless, patients with a history of endoscopic sinus surgery were more likely to travel longer distances to obtain care (Cliff delta = 0.28; 95% CI, 0.19-0.38). CONCLUSIONS AND RELEVANCEAlthough this cross-sectional study found that some patients appear more willing to travel longer distances for chronic rhinosinusitis care, results suggest that distance traveled to academic tertiary care centers was not associated with disease severity, outcomes, or comorbidity burden. These findings argue for greater generalizability of study results across various cohorts independent of distance traveled to obtain rhinologic care.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Evaluating Distance Bias in Chronic Rhinosinusitis Outcomes

Gill

Beswick

Mace

et al. 2022

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

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“…[22][23][24] However, this pattern is not found in cardiac surgery. Hawkins et al 25 previously demonstrated that increased travel distance and bypassing the nearest surgical center is associated with lower operative mortality in patients undergoing cardiac valve surgery. Our results are consistent with these findings by showing that beneficiaries living in HPSAs traveled significantly further for care and experienced comparable postoperative 30-day outcomes compared with beneficiaries living in non-HPSAs.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Surgery Among Medicare Beneficiaries in Health Professional Shortage Areas

et al. 2022

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Objective: Health professional shortage areas (HPSAs) were created by the Health Resources and Services Administration to identify communities with a shortage of clinical providers. For medical conditions, these designations are associated with worse outcomes. However, far less is known about patients undergoing high-complexity surgical procedures, such as coronary artery bypass grafting (CABG). Background: The aim was to compare postoperative surgical outcomes of high-complexity surgery in beneficiaries living in HPSA versus non-HPSA designated areas. Methods: This study is a retrospective cohort review of Medicare beneficiaries who underwent CABG between 2014 and 2018. The authors compared risk-adjusted 30-day mortality, complication, reoperation, and readmission rates for beneficiaries living in a designated HPSA versus non-HPSA using a multivariable logistic regression model accounting for patient (eg, age, sex, comorbidities, surgery year) and hospital characteristics (eg, patient-to-nurse ratio, teaching status). Patient travel burden was measured based on the time and distance required to travel from the beneficiary’s home zip code to the hospital zip code. Results: Of the 370,532 Medicare beneficiaries who underwent CABG, 30,881 (8.3%) lived in a HPSA. Beneficiaries in HPSAs were found to experience comparable 30-day mortality (3.50% vs. 3.65%, P<0.001), complication (32.67% vs. 33.54%, P<0.001), reoperation (1.58% vs. 1.66%, P<0.001), and readmission (14.72% vs. 14.86%, P<0.001) rates. Beneficiaries experienced greater mean travel times (91.2 vs. 64.0 minutes, P<0.001) and mean travel distances (85.0 vs. 59.3 miles, P<0.001). Conclusions: Medicare beneficiaries living in designated HPSA experienced comparable surgical outcomes after CABG surgery but a significantly greater travel burden. The greater travel burden experienced by patients living in designated shortage areas to obtain comparable surgical care for complex procedures demonstrates important tradeoffs between access and quality.

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Section: Discussionmentioning

confidence: 99%

“…Hawkins et al 14 investigated the effect of distance on outcomes and survival of patients undergoing valve repair and coronary artery bypass grafting (CABG) surgery. They found that distant travelers had better outcomes compared to nontravelers 14 . In a retrospective single‐center study, Tsuang et al 15 found no significant relationship between recipient travel distance and post lung transplant graft survival.…”

Section: Discussionmentioning

confidence: 99%

Impact of distance from implant center on mechanical circulatory device patient outcomes

et al. 2021

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Objectives Patients on left ventricular assist device (LVAD) support receive extensive care and education before discharge home. We investigated the impact of patient's residential distance from LVAD implantation center on outcomes and survival. Methods A total of 214 patients received a LVAD between 2006 and 2018 at our institution. Patient's residential distance from the LVAD implantation center, LVAD complications, hospitalization, and death were recorded. Patients were divided into two groups: patients living less than or equal to 100 miles (Group 1), patients living more than 100 (Group 2). Results A total of 106 patients were assigned to Group 1 and 108 patients were assigned to Group 2. Destination therapy was intended in 20% of patients in Group 1 and 34% in Group 2 (p = .023). Mean length of stay was 13 ± 9 days for Group 1 and 21 ± 12 for Group 2 (p < .001). Major postoperative complications were unplanned readmissions due to infections (9% and 12%), gastrointenstinal bleeding (15% and 14%), cerebrovascular accidents (6% and 7.4%), and acute kidney injury (5% and 2%), respectively for Group 1 and Group 2. There was no difference in major complications (all p > .05) and survival between patients in both groups (p > .05). Conclusions Distance from implanting center had no impact on adverse outcomes after LVAD implantation. There was a significant increase in hospital stay for patients who live far from the implanting center, suggesting that distance should not be a contraindication when considering patients for LVAD therapy, but plans should be made for prolonged hospital stay or extended local stay near the hospital for close follow‐up.

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Travel distance and regional access to cardiac valve surgery

Cited by 8 publications

References 23 publications

Evaluating Distance Bias in Chronic Rhinosinusitis Outcomes

Evaluating Distance Bias in Chronic Rhinosinusitis Outcomes

Coronary Artery Bypass Surgery Among Medicare Beneficiaries in Health Professional Shortage Areas

Impact of distance from implant center on mechanical circulatory device patient outcomes

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