Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?.

MedStar author(s):
Citation: Journal of the American College of Surgeons. , 2017 Apr 13Journal of the American College of Surgeons. 225(2):216-225, 2017 AugPMID: 28414114Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment: Surgery/General SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Health Services Accessibility/sn [Statistics & Numerical Data] | *Pancreatectomy | *Pancreatic Neoplasms/su [Surgery] | Aged | Aged, 80 and over | Cohort Studies | Female | Hospitals, High-Volume | Humans | Male | Middle Aged | Pancreatectomy/mo [Mortality] | Pancreatectomy/sn [Statistics & Numerical Data] | Retrospective Studies | Treatment Outcome | United StatesYear: 2017Local holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007ISSN:
  • 1072-7515
Name of journal: Journal of the American College of SurgeonsAbstract: 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.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. Copyright (c) 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.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.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.All authors: Al-Refaie WB, Dudeja V, Hong YK, Ihemelandu CU, Jindal M, Johnson LB, Quadri HS, Shara NM, Smith AK, Zheng CFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-05-06
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 28414114 Available 28414114

Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007

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.

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. Copyright (c) 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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.

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.

English

Powered by Koha