Division of General Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada.
Department of Surgery, McMaster University, Hamilton, ON, Canada.
Surg Endosc. 2019 Apr;33(4):1167-1173. doi: 10.1007/s00464-018-6383-x. Epub 2018 Aug 16.
While high-volume Centers of Excellence (COE) for bariatric surgery may have improved clinical outcomes, their disparate distribution results in longer travel distances for patients. The purpose of this study was to investigate effect of distance from COE on outcomes and readmission.
This was a retrospective study of all adults, aged 18 years or older, receiving bariatric surgery from April 2009 to March 2012 in the province of Ontario. Main outcomes included 30-day complication rates and readmission. Multivariable logistic regression was used to examine the impact of distance from patients' primary residence to their bariatric COE on patient outcomes and readmissions.
Five thousand and seven patients were identified, two-thirds residing within 100 km of a COE with a mean distance of 117.2 km. The majority of patients did not reside within a Local Integrated Health Network (LHIN) that contained a COE, while 18.3% of patients lived in rural areas. Using multivariable adjustment, for every 10 km increase from the COE where surgery was performed, the Odds Ratio (OR) for complications was 1.00 [95% Confidence Interval (CI) 0.99-1.01; P = 0.747]. Additionally, both residing in a LHIN without a COE, OR 1.10 (95% CI 0.87-1.40; P = 0.434), and rural status, OR 0.97 (95% CI 0.77-1.23; P = 0.821) showed no increase in risk of complication. Similarly, further distances did not influence rate of readmission, OR 0.99 (95% CI 0.98-1.00; P = 0.077) nor did rural status OR 1.31 (95% CI 0.97-1.76; P = 0.076).
The COE model, where a few centers in high population areas service a large geographic region, is adequate in ensuring patients that live further away receive appropriate short-term care.
虽然卓越医疗中心（COE）进行减重手术可能改善了临床结果，但它们的分布不均导致患者的旅行距离延长。本研究旨在探讨距离 COE 的远近对结果和再入院的影响。
这是一项回顾性研究，纳入了 2009 年 4 月至 2012 年 3 月在安大略省接受减重手术的所有 18 岁及以上成年人。主要结果包括 30 天并发症发生率和再入院率。多变量逻辑回归用于检查患者居住地到减重 COE 的距离对患者结局和再入院的影响。
共确定了 5070 名患者，其中三分之二的患者居住在距离 COE 100 公里以内，平均距离为 117.2 公里。大多数患者的居住地不在包含 COE 的本地综合卫生网络（LHIN）内，而 18.3%的患者居住在农村地区。使用多变量调整后，与手术所在 COE 每增加 10 公里，并发症的优势比（OR）为 1.00[95%置信区间（CI）0.99-1.01；P=0.747]。此外，居住在没有 COE 的 LHIN 内（OR 1.10，95%CI 0.87-1.40；P=0.434）和农村地区（OR 0.97，95%CI 0.77-1.23；P=0.821）并没有增加并发症的风险。同样，更远的距离也没有影响再入院率，OR 0.99（95%CI 0.98-1.00；P=0.077），农村地区也没有影响 OR 1.31（95%CI 0.97-1.76；P=0.076）。
在高人口地区的少数中心服务于广大地理区域的 COE 模式足以确保居住在更远地方的患者接受适当的短期治疗。
