Search

Background: Data on the impact of hospital volume and travel distance on patient outcomes after major abdominal surgery remain poorly defined. We sought to characterize the relationship of travel distance, hospital volume, and long-term outcomes of patients undergoing surgical resection of hepatocellular carcinoma (HCC).Methods: The 2004-2015 National Cancer Database was used to identify patients who underwent resection of HCC. Patients were stratified according to travel distance and hospital volume quartiles, and multivariable regression models were utilized to examine the impact of travel distance, hospital volume, and travel distance/hospital volume on overall survival (OS).Results: Among the 12,266 patients identified, procedures included wedge/segmental resections (N = 7354, 59.9%), hemi-hepatectomy (N = 4003, 32.6%), and extended hepatectomy (N = 909, 7.5%). Stratifying data into quartiles, travel distance to surgical care was ≤ 5.7 miles (mi), > 5.7-14.2 mi, > 14.2-44.4 mi, and ≥ 44.4 mi, while hospital volume quartiles determined on the hospital level were ≤ 1 case per year, 1.1-4, 4.1-12.5, and ≥ 12.5. On multivariable analysis, increased hospital volume was associated with decreased hazard of mortality (HR 0.69, 95% CI 0.45-0.82, p < 0.001). Travel distance was not significantly associated with hazard of mortality. Furthermore, only hospital volume was associated with mortality (HR 0.67, 95% CI 0.56-0.80, p < 0.001) after controlling for both travel distance and hospital volume.Conclusions: Only hospital volume was associated with increased hazard of mortality. The benefits of undergoing resection for HCC at a high-volume hospital appear to outweigh the inconvenience of longer travel distances. [ABSTRACT FROM AUTHOR]

Background: The objective of the current study was to characterize the association between travel distance/hospital volume relative to outcomes following resection of cholangiocarcinoma.Methods: 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.Results: 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.Conclusions: 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. [ABSTRACT FROM AUTHOR]

Background: Surgical resection of extrahepatic biliary malignancies has been increasingly centralized at high-volume tertiary care centers. While this has improved outcomes overall, increased travel burden has been associated with worse survival for many other malignancies. We hypothesized that longer travel distances are associated with worse outcomes for these patients as well.Study Design: Data was analyzed from the US Extrahepatic Biliary Consortium database, which retrospectively reviewed patients who received resection of extrahepatic biliary malignancies at 10 high-volume centers. Driving distance to the patient's treatment center was measured for 1025 patients. These were divided into four quartiles for analysis: < 24.5, 24.5-57.2, 57.2-117, and < 117 mi. Cox proportional hazard models were then used to measure differences in overall survival.Results: No difference was found between the groups in severity of disease or post-operative complications. The median overall survival in each quartile was as follows: 1st = 1.91, 2nd = 1.60, 3rd = 1.30, and 4th = 1.39 years. Patients in the 3rd and 4th quartile had a significantly lower median household income (p = 0.0001) and a greater proportion Caucasian race (p = 0.0001). However, neither of these was independently associated with overall survival. The two furthest quartiles were found to have decreased overall survival (HR = 1.39, CI = 1.12-1.73 and HR = 1.3, CI = 1.04-1.62), with quartile 3 remaining significant after multivariate analysis (HR = 1.45, CI = 1.04-2.0, p = 0.028).Conclusions: Longer travel distances were associated with decreased overall survival, especially in the 3rd quartile of our study. Patients traveling longer distances also had a lower household income, suggesting that these patients have significant barriers to care. [ABSTRACT FROM AUTHOR]