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Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?
- Source :
- Journal of the American College of Surgeons. 225:216-225
- Publication Year :
- 2017
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2017.
-
Abstract
- 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.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.Median travel distance to undergo pancreatectomy increased from 16.5 to 18.7 miles (p for trend0.001). 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.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.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Patient demographics
Negative association
Article
Health Services Accessibility
Cohort Studies
03 medical and health sciences
Pancreatectomy
0302 clinical medicine
medicine
Humans
Intensive care medicine
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Cancer stage
Retrospective cohort study
Middle Aged
medicine.disease
Comorbidity
United States
Pancreatic Neoplasms
Treatment Outcome
030220 oncology & carcinogenesis
National study
Female
030211 gastroenterology & hepatology
Surgery
business
Hospitals, High-Volume
Demography
Cohort study
Subjects
Details
- ISSN :
- 10727515
- Volume :
- 225
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Surgeons
- Accession number :
- edsair.doi.dedup.....b4000009fe6266bb66d5e67fe9048f0d