Objectives To characterize patient travel distance to a comprehensive cancer center (CC) for gynecologic surgery; to determine the impact of travel distance on perioperative quality indicators.
Methods Patients who underwent first gynecologic surgery at a CC from 1/2000–3/2018 were identified. Travel distance was defined as ‘‘‘‘‘close’’’’’ (≤50 mi) or ‘‘‘‘‘far’’’’’ (>50 mi). Patient demographics, procedural complexity, rates of reoperation, reporting to improve safety and quality (RISQ) events, and postoperative mortality were identified.
Results Of 23,340 patients, 19,246 were included in the close group and 4,094 in the far group. Median distance traveled was 19.25mi (range 0–4963): 14.35mi for close group, 85.21mi far group. Median age was 55 years (range 18–97). There was no difference in age (p=0.87) or ASA status (p=0.16) between groups. Patients in the far group underwent more complex procedures based on RVUs (p=0.00) and case length (p=0.00) and had 1-day longer length of stay (p=0.003). There were more non-White (p=0.00), non-English speaking (p=0.00), and unmarried (p=0.00) patients in the close group. There was no difference in rate of reoperation (p=0.95) or 30-, 60-, or 90-day mortality (p=0.35, 0.80, 0.34) between groups. Patients who traveled farther had 1% more RISQ events (p=0.003), but this did not hold on multivariate analysis.
Conclusions We demonstrate that patients who travel for centralized specialty gynecologic surgical care have more complex procedures, more perioperative adverse events, and longer length of stay, without negative impact on perioperative quality of care, reoperation, or postoperative mortality.
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