MedStar Authors catalog › Details for: Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?.
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Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?.

by Quadri, Humair S; Ihemelandu, Chukwuemeka; Shara, Nawar M; Al-Refaie, Waddah B.
Citation: Journal of the American College of Surgeons. , 2017 Apr 13; Journal of the American College of Surgeons. 225(2):216-225, 2017 Aug.Journal: Journal of the American College of Surgeons.Published: 2017ISSN: 1072-7515.Full author list: Jindal M; Zheng C; Quadri HS; Ihemelandu CU; Hong YK; Smith AK; Dudeja V; Shara NM; Johnson LB; Al-Refaie WB.UI/PMID: 28414114.Subject(s): Aged | Aged, 80 and over | Cohort Studies | Female | *Health Services Accessibility/sn [Statistics & Numerical Data] | Hospitals, High-Volume | Humans | Male | Middle Aged | Pancreatectomy/mo [Mortality] | Pancreatectomy/sn [Statistics & Numerical Data] | *Pancreatectomy | *Pancreatic Neoplasms/su [Surgery] | Retrospective Studies | Treatment Outcome | United StatesInstitution(s): MedStar Washington Hospital Center | MedStar Health Research InstituteDepartment(s): Surgery/General SurgeryActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: J Am Coll Surg. , 2017 Apr 13; J Am Coll Surg. 225(2):216-225, 2017 Aug.Local Holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007.Abstract: 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.Abstract: 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.Abstract: 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.Abstract: 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.

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