Tripler Army Medical Center, Honolulu HI (GEL, JW).
Evans Army Community Hospital, Fort Carson, CO (DGY).
Hawaii J Health Soc Welf. 2021 May;80(5):108-114.
As the health care delivery system in the United States changes, there has been an increase in the presence of specialized medical centers, translating into increased travel distance for patients. Tripler Army Medical Center in Honolulu, Hawai'i serves a unique population of local patients and those traveling from neighboring Hawaiian Islands and from across the Pacific Basin and Asia. Previous studies have examined the role of distance traveled, but no study has looked at patients routinely flying in the immediate postoperative period. The purpose of this study is to investigate if increased travel distance is associated with a higher probability of complications after a total joint arthroplasty (TJA). A retrospective review of all patients receiving TJA at a single medical institution was performed. After meeting the inclusion criteria, 126 consecutive patients were reviewed for 30-day complications. Sixty-four patients were local (from O'ahu, Hawai'i), and 13 from neighboring Hawaiian Islands, while 49 were international. There were no significant differences in complications between the groups. Length of stay was not affected by distance. A significant risk factor for short-term complications was having a higher score based on the American Society of Anesthesiologists Physical Status Classification System (ASA), ASA 3 vs ASA 1&2 (14% vs 1%, = .015). There were no findings in our population to support inferior outcomes in patients traveling from the outer Pacific Basin during their initial postoperative course compared to the local population. No patient sustained a short-term complication after a patient returned to their island or country of origin. The results of this study will help to guide clinical decision making and effective resource management for patients seeking TJA traveling from a significant distance.
随着美国医疗保健提供系统的变化，专门的医疗中心的数量有所增加，这意味着患者的旅行距离也增加了。檀香山的 Tripler 陆军医疗中心为当地患者以及来自夏威夷群岛和太平洋盆地及亚洲其他地区的旅行者提供独特的服务。以前的研究已经考察了旅行距离的作用，但没有研究关注在术后即刻乘机旅行的患者。本研究旨在探讨总关节置换术后（TJA）患者的旅行距离增加是否与并发症发生的可能性增加有关。对一家医疗机构接受 TJA 的所有患者进行回顾性研究。符合纳入标准后，对 126 例连续患者进行 30 天并发症回顾。64 例患者为本地（来自夏威夷的瓦胡岛），13 例来自邻近的夏威夷群岛，而 49 例来自国际。各组之间的并发症无显著差异。住院时间不受距离影响。短期并发症的一个显著危险因素是根据美国麻醉医师协会身体状况分类系统（ASA）的评分较高，ASA 3 与 ASA 1&2（14%与 1%，P=.015）。在我们的人群中，没有发现证据表明来自外太平洋盆地的患者在术后初期的治疗结果不如当地人群。没有患者在返回其所在岛屿或原籍国后发生短期并发症。本研究的结果将有助于指导临床决策和对从远距离寻求 TJA 的患者进行有效的资源管理。
