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Travel Patterns among Patients Undergoing Hepatic Resection in California: Does Driving Further for Care Improve Outcomes?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Better outcomes at high-volume surgical centers have driven regionalization of complex surgical care. In turn, access to high-volume centers often requires travel over longer distances. We sought to characterize travel patterns among patients who underwent a hepatectomy.

Methods

The California Office of Statewide Health Planning database was used to identify patients who underwent hepatectomy between 2005 and 2016. Total distance traveled and whether a patient bypassed the nearest hospital that performed hepatectomy to get to a higher-volume center were assessed. Multivariate analyses were used to identify factors associated with bypassing a local hospital for a higher-volume center.

Results

Overall, 13,379 adults underwent a hepatectomy in 229 hospitals; only 26 hospitals were high volume (> 15 cases/year). Median travel time to a hospital that performed hepatectomy was 25.2 min (IQR: 13.1–52.0). The overwhelming majority of patients (91.6%) bypassed the nearest providing hospital to seek care at a destination hospital. Among patients who bypassed a closer hospital, 75.5% went to a high-volume hospital. Outcomes at destination hospitals were improved compared with nearest hospitals (incidence of complications: 20.4% vs. 22.9% %; failure-to-rescue: 7.1% vs 10.9%; mortality 1.5% vs. 2.6%). Medicaid beneficiaries (OR 0.69, 95%CI 0.56–0.85) were less likely to bypass the nearest hospital to go to a high-volume hospital; additionally, Medicaid patients were less likely to undergo hepatectomy at a high-volume hospital independent of bypassing the nearest hospital (OR 0.60, 95%CI 0.48–0.76). Among the 3703 patients who underwent hepatectomy at a low-volume center, 2126 patients had actually bypassed a high-volume hospital. Among the remaining 1577 patients, 95% of individuals would have needed to travel less than 1 additional hour to reach a high-volume center.

Conclusion

Roughly, one-quarter of patients undergoing hepatectomy received care at a low-volume center; nearly all of these patients either bypassed a high-volume hospital or would have needed to travel less than an additional hour to reach a high-volume center. Travel distance needs to be considered in policies and healthcare delivery design to improve care of patients undergoing hepatic resection.

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Authors and Affiliations

  1. The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Adrian Diaz, Jordan M Cloyd, Andrei Manilchuk, Mary Dillhoff, Joel Beane, Allan Tsung, Aslam Ejaz & Timothy M. Pawlik

  2. National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA

    Adrian Diaz

  3. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA

    Adrian Diaz

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  1. Adrian Diaz
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  2. Jordan M Cloyd
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Correspondence to Adrian Diaz.

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Dr. Diaz received salary support from the Veterans Affairs Office of Academic Affiliations during the time of the study.

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Diaz, A., Cloyd, J.M., Manilchuk, A. et al. Travel Patterns among Patients Undergoing Hepatic Resection in California: Does Driving Further for Care Improve Outcomes?. J Gastrointest Surg 25, 1471–1478 (2021). https://doi.org/10.1007/s11605-019-04501-9

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