Travel Distance Does Not Affect Outcomes in Hip Preservation Surgery: A Case for Centers of Excellence

Abstract

Background: Previous studies have evaluated the effect of distance to high-volume centers on outcomes after joint replacement. However, there is limited evidence on whether this distance has an effect on outcomes after undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS). Purpose: To determine whether increased distance from a patient’s home to his or her primary orthopaedic clinic has an influence on the ability to achieve the minimal clinically important difference (MCID) on outcome measures after surgery for FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort analysis was performed on patients undergoing surgery for FAIS by a single surgeon from January 2012 through January 2017. A total of 692 patients were identified and split into 2 groups: driving distance of <50 miles from our institution (referral group) and driving distance of <50 miles from our institution (local group). Preoperative and 2-year postoperative scores on patient-reported outcome measures (PROMs), including the Hip Outcome Score Activities of Daily Living and Sport-Specific subscales, International Hip Outcome Tool–12, and modified Harris Hip Score, were assessed. Patients achieving the MCID on any included PROM were analyzed using a chi-square analysis. Logistic regression was performed to determine whether driving distance and other demographic variables of interest had an effect on achieving the MCID. Study data were analyzed using PatientIQ, a cloud-based research and analytics platform for health care. Results: There were 647 patients who completed 2-year follow-up and were included in the analysis. Of these patients, 116 (17.9%) were identified as being ≥50 miles from their orthopaedic provider, and 531 (82.1%) were identified as having a driving distance of <50 miles. A total of 100 patients (86.2%) in the referral group reached the MCID, and 476 patients (89.6%) in the local group reached the MCID. There was no statistically significant difference in reaching the MCID on any of the included PROMs between the 2 groups ( P = .364). The same result held when controlling for a number of factors including age, body mass index, and adjusted gross income with logistic regression. Conclusion: When controlling for a number of factors including age, body mass index, and adjusted gross income, distance to a high-volume hip arthroscopic surgery center did not have an effect on postoperative outcome scores or achieving the MCID 2 years after undergoing surgery for FAIS.

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

“…chose 50 miles as the distance threshold in their study of hip arthroscopies, the previous study examining travel distance on outcomes after total joint arthroplasty by Nwachukwu et al. was performed at the same institution as ours and also used a 100-mile radius [ 9 , 10 ].…”

“…However, in a separate study, patients living further from a tertiary care center had an increased risk of postoperative complication after a general surgery procedure compared with those closer by [8]. In the orthopaedic surgery literature, the results have been more consistent as several studies have demonstrated that travel distance has no effect on both short-term and long-term postoperative outcomes in patients undergoing total joint arthroplasty and hip arthroscopy [9][10][11]. No study, however, has examined the impact of travel distance on outcomes after hip resurfacing arthroplasty (HRA).…”

“…To further characterize the clinical significance of changes as measured on these PROMs, the minimal clinically important difference (MCID) was determined for each instrument. The distribution-based method, as previously described in the literature, was used in this study [ 9 , 24 , 25 ]. Briefly, the threshold for achieving the MCID for each instrument was determined by calculating the change in outcome equal to 0.5 standard deviation over a 2-year period.…”

“…Furthermore, the distance of one hundred miles was chosen based on the specific characteristics of our hospital's metropolitan area and is thus not a validated distance. While Beck et al chose 50 miles as the distance threshold in their study of hip arthroscopies, the previous study examining travel distance on outcomes after total joint arthroplasty by Nwachukwu et al was performed at the same institution as ours and also used a 100-mile radius [9,10].…”

“…While these studies examined overall complications, a recent study explored the impact of travel distance on patientreported outcome measures in the field of sports medicine. Beck et al stratified 647 patients undergoing hip arthroscopy into those traveling greater than and less than 50 miles to their high-volume surgical center [9]. In addition to noting that there were no differences in baseline demographics between the groups, they also determined that both groups had similar 2-year patient-reported outcome scores [9].…”