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

doi:10.1016/j.jamcollsurg.2017.04.003

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Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?

Journal article

Peer reviewed

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 and Waddah B Al-Refaie

Journal of the American College of Surgeons, Vol.225(2), pp.216-225

08/01/2017

DOI: 10.1016/j.jamcollsurg.2017.04.003

PMID: 28414114

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Abstract

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. 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. 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. 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.

Aged

Aged, 80 and over

Cohort Studies

Female

Health Services Accessibility - statistics & numerical data

Hospitals, High-Volume

Humans

Male

Middle Aged

Pancreatectomy - mortality

Pancreatectomy - statistics & numerical data

Pancreatic Neoplasms - surgery

Retrospective Studies

Treatment Outcome

United States

Details

Title: Subtitle: Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?
Creators: Manila Jindal - MedStar Georgetown University Hospital
Chaoyi Zheng - Georgetown University
Humair S Quadri - Georgetown University
Chukwuemeka U Ihemelandu - MedStar Georgetown University Hospital
Young K Hong - MedStar Georgetown University Hospital
Andrew K Smith - Georgetown University Medical Center
Vikas Dudeja - University of Miami
Nawar M Shara - Howard University
Lynt B Johnson - MedStar Georgetown University Hospital
Waddah B Al-Refaie - Georgetown University Medical Center
Resource Type: Journal article
Publication Details: Journal of the American College of Surgeons, Vol.225(2), pp.216-225
DOI: 10.1016/j.jamcollsurg.2017.04.003
PMID: 28414114
ISSN: 1072-7515
eISSN: 1879-1190
Grant note: UL1 TR001409 / NCATS NIH HHS
Language: English
Date published: 08/01/2017
Academic Unit: Anatomy and Cell Biology; Surgery
Record Identifier: 9985244575802771

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