Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?

Manila Jindal, Chaoyi Zheng, Humair S. Quadri, Chukwuemeka U. Ihemelandu, Young K. Hong, Andrew K. Smith, Vikas Dudeja, Nawar M. Shara, Lynt B. Johnson, Waddah B. Al-Refaie

Research output: Contribution to journalArticle

19 Citations (Scopus)

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. 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. 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. 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.

Original languageEnglish (US)
Pages (from-to)216-225
Number of pages10
JournalJournal of the American College of Surgeons
Volume225
Issue number2
DOIs
StatePublished - Aug 1 2017

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Pancreatectomy
Mortality
High-Volume Hospitals
Neoplasms
Rural Population
Comorbidity
Demography
Databases
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Jindal, M., Zheng, C., Quadri, H. S., Ihemelandu, C. U., Hong, Y. K., Smith, A. K., ... Al-Refaie, W. B. (2017). Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes? Journal of the American College of Surgeons, 225(2), 216-225. https://doi.org/10.1016/j.jamcollsurg.2017.04.003

Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes? / Jindal, Manila; Zheng, Chaoyi; Quadri, Humair S.; Ihemelandu, Chukwuemeka U.; Hong, Young K.; Smith, Andrew K.; Dudeja, Vikas; Shara, Nawar M.; Johnson, Lynt B.; Al-Refaie, Waddah B.

In: Journal of the American College of Surgeons, Vol. 225, No. 2, 01.08.2017, p. 216-225.

Research output: Contribution to journalArticle

Jindal, M, Zheng, C, Quadri, HS, Ihemelandu, CU, Hong, YK, Smith, AK, Dudeja, V, Shara, NM, Johnson, LB & Al-Refaie, WB 2017, 'Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?', Journal of the American College of Surgeons, vol. 225, no. 2, pp. 216-225. https://doi.org/10.1016/j.jamcollsurg.2017.04.003
Jindal, Manila ; Zheng, Chaoyi ; Quadri, Humair S. ; Ihemelandu, Chukwuemeka U. ; Hong, Young K. ; Smith, Andrew K. ; Dudeja, Vikas ; Shara, Nawar M. ; Johnson, Lynt B. ; Al-Refaie, Waddah B. / Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?. In: Journal of the American College of Surgeons. 2017 ; Vol. 225, No. 2. pp. 216-225.
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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. 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. 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. 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.",
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