Journal of Gastrointestinal Surgery

, Volume 23, Issue 5, pp 944–952 | Cite as

Association Between Travel Distance, Hospital Volume, and Outcomes Following Resection of Cholangiocarcinoma

  • Eliza W. Beal
  • Rittal Mehta
  • J. Madison Hyer
  • Anghela Paredes
  • Katiuscha Merath
  • Mary E. Dillhoff
  • Jordan Cloyd
  • Aslam Ejaz
  • Timothy M. PawlikEmail author
Original Article



The objective of the current study was to characterize the association between travel distance/hospital volume relative to outcomes following resection of cholangiocarcinoma.


Patients were identified using the 2004–2015 National Cancer Database and stratified into quartiles according to travel distance/hospital volume. Multivariable regression models were utilized to examine the impact of travel distance and hospital volume on quality-of-care metrics and overall survival.


Among 5125 patients, the majority of patients had T1/2 (N = 2006, 41.1%) and N0 disease (N = 2498, 50.9%). Median hospital quartile surgical volumes in cases/year were low volume (LV) 6, intermediate low volume (ILV) 7, intermediate high volume (IHV) 12, and high volume (HV) 24 cases/year. Median travel distance quartiles in miles were short travel (ST) 2.7, intermediate short travel (IST) 7.9, intermediate long travel (ILT) 18.9, and long travel (LT) 84.7. Longer travel distances were associated with better overall survival, as every 10 miles was associated with a 2% decrease in mortality (p = 0.02). Differences in quality-of-care metrics were largely mediated through travel distance.


Travel distance and hospital volume were associated with certain quality-of-care metrics among patients with cholangiocarcinoma. After controlling for hospital volume and travel distance simultaneously, only travel distance was associated with decreased risk of mortality.


Travel distance Hospital volume 


Author Contribution

EWB, RM, JMH, AP, KM, MED, JC, AE, and TMP conceived of and designed this work. RM and EWB performed the data analysis. EWB drafted the manuscript. EWB, RM, JMH, AP, KM, MED, JC, AE, and TMP critically revised the manuscript, provided approval of the final version, and agree to be accountable for all aspects of the work.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet. 2014;383(9935):2168–79.CrossRefGoogle Scholar
  2. 2.
    DeOliveira ML. Liver transplantation for cholangiocarcinoma: current best practice. Curr Opin Organ Transplant. 2014;19(3):245–52.CrossRefGoogle Scholar
  3. 3.
    Squires MH, Cloyd JM, Dillhoff M, Schmidt C, Pawlik TM. Challenges of surgical management of intrahepatic cholangiocarcinoma. Expert Rev Gastroenterol Hepatol. 2018;12(7):671–81.CrossRefGoogle Scholar
  4. 4.
    Kimbrough CW, Cloyd JM, Pawlik TM. Surgical approaches for the treatment of perihilar cholangiocarcinoma. Expert Rev Anticancer Ther. 2018;18(7):673–83.CrossRefGoogle Scholar
  5. 5.
    Macedo FIB, Jayanthi P, Mowzoon M, Yakoub D, Dudeja V, Merchant N. The Impact of Surgeon Volume on Outcomes After Pancreaticoduodenectomy: a Meta-analysis. J Gastrointest Surg. 2017;21(10):1723–31.CrossRefGoogle Scholar
  6. 6.
    Gani F, Johnston FM, Nelson-Williams H, Cerullo M, Dillhoff ME, Schmidt CR, et al. Hospital Volume and the Costs Associated with Surgery for Pancreatic Cancer. J Gastrointest Surg. 2017;21(9):1411–9.CrossRefGoogle Scholar
  7. 7.
    Dimick JB, Cowan JA, Knol JA, Upchurch GR. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database. Arch Surg. 2003;138(2):185–91.CrossRefGoogle Scholar
  8. 8.
    Mukherjee S, Kocher HM, Hutchins RR, Bhattacharya S, Abraham AT. Impact of hospital volume on outcomes for pancreaticoduodenectomy: a single UK HPB centre experience. Eur J Surg Oncol. 2009;35(7):734–8.CrossRefGoogle Scholar
  9. 9.
    Kagedan DJ, Goyert N, Li Q, Paszat L, Kiss A, Earle CC, et al. The Impact of Increasing Hospital Volume on 90-Day Postoperative Outcomes Following Pancreaticoduodenectomy. J Gastrointest Surg. 2017;21(3):506–15.CrossRefGoogle Scholar
  10. 10.
    Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349(22):2117–27.CrossRefGoogle Scholar
  11. 11.
    Gani F, Azoulay D, Pawlik TM. Evaluating Trends in the Volume-Outcomes Relationship Following Liver Surgery: Does Regionalization Benefit All Patients the Same? J Gastrointest Surg. 2017;21(3):463–71.CrossRefGoogle Scholar
  12. 12.
    Adam MA, Thomas S, Youngwirth L, Pappas T, Roman SA, Sosa JA. Defining a Hospital Volume Threshold for Minimally Invasive Pancreaticoduodenectomy in the United States. JAMA Surg. 2017;152(4):336–42.CrossRefGoogle Scholar
  13. 13.
    Ross K, Patzer RE, Goldberg DS, Lynch RJ. Sociodemographic Determinants of Waitlist and Posttransplant Survival Among End-Stage Liver Disease Patients. Am J Transplant. 2017;17(11):2879–89.CrossRefGoogle Scholar
  14. 14.
    Lidsky ME, Sun Z, Nussbaum DP, Adam MA, Speicher PJ, Blazer DG. Going the Extra Mile: Improved Survival for Pancreatic Cancer Patients Traveling to High-volume Centers. Ann Surg. 2017;266(2):333–8.CrossRefGoogle Scholar
  15. 15.
    Xia L, Taylor BL, Mamtani R, Christodouleas JP, Guzzo TJ. Associations Between Travel Distance, Hospital Volume, and Outcomes Following Radical Cystectomy in Patients With Muscle-invasive Bladder Cancer. Urology. 2018;114:87–94.CrossRefGoogle Scholar
  16. 16.
    Boffa DJ, Rosen JE, Mallin K, Loomis A, Gay G, Palis B, et al. Using the National Cancer Database for Outcomes Research: A Review. JAMA Oncol. 2017;3(12):1722–8.CrossRefGoogle Scholar
  17. 17.
    NCDB. Getting started—a user’s guide. 2015.Google Scholar
  18. 18.
    Jindal M, Zheng C, Quadri HS, Ihemelandu CU, Hong YK, Smith AK, et al. Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes? J Am Coll Surg. 2017;225(2):216–25.CrossRefGoogle Scholar
  19. 19.
    Desch CE, McNiff KK, Schneider EC, Schrag D, McClure J, Lepisto E, et al. American Society of Clinical Oncology/National Comprehensive Cancer Network Quality Measures. J Clin Oncol. 2008;26(21):3631–7.CrossRefGoogle Scholar
  20. 20.
    Bagante F, Gani F, Beal EW, Merath K, Chen Q, Dillhoff M, et al. Prognosis and Adherence with the National Comprehensive Cancer Network Guidelines of Patients with Biliary Tract Cancers: an Analysis of the National Cancer Database. J Gastrointest Surg. 2018.Google Scholar
  21. 21.
    Reardon ZD, Patel SG, Zaid HB, Stimson CJ, Resnick MJ, Keegan KA, et al. Trends in the use of perioperative chemotherapy for localized and locally advanced muscle-invasive bladder cancer: a sign of changing tides. Eur Urol. 2015;67(1):165–70.CrossRefGoogle Scholar
  22. 22.
    O’Connor SC, Mogal H, Russell G, Ethun C, Fields RC, Jin L, et al. The Effects of Travel Burden on Outcomes After Resection of Extrahepatic Biliary Malignancies: Results from the US Extrahepatic Biliary Consortium. J Gastrointest Surg. 2017;21(12):2016–24.CrossRefGoogle Scholar
  23. 23.
    Birkmeyer JD, Siewers AE, Marth NJ, Goodman DC. Regionalization of high-risk surgery and implications for patient travel times. JAMA. 2003;290(20):2703–8.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of Surgery, Division of Surgical OncologyThe Ohio State University Wexner Medical CenterColumbusUSA

Personalised recommendations