Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
Virginia Cardiac Surgery Quality Initiative, Falls Church, Virginia.
J Surg Res. 2022 Mar;271:52-58. doi: 10.1016/j.jss.2021.10.022. Epub 2021 Nov 24.
Negative health effects of traveling longer distances for surgical services have been reported. Given the high complexity of multidisciplinary care required for management of Left Ventricular Assist Device (LVAD) implantation, only 4 of 18 centers in our state perform these operations. Given the limited access we hypothesized increased travel time would adversely affect postoperative outcomes and 30-d mortality.
A statewide Society of Thoracic Surgeons database was queried to identify patients undergoing Heartmate II/III and HVAD implantation, and 725 patients were identified. Travel time was calculated by zip code. Patients were stratified into regional and distant groups by the upper quartile of travel time (1-h). Preoperative variables and outcomes were compared between the groups. Multivariate analysis was performed to evaluate the impact of travel time in risk-adjusted models of 30-d mortality.
Median patient travel time to their LVAD center in our state is 32 min (mean 53 ± 65 min, 46 ± 71 miles). Patients in the distant group (n = 191) had lower median incomes, higher self-pay status, higher rates of medical comorbid disease. Despite these differences there was no difference between the groups in ICU and/or hospital length of stay, readmission, postoperative complications, or 30-d mortality. Multivariate regression demonstrated insurance status, age, and prior surgery predicted 30-d mortality, but not travel time.
Despite only four centers in the state performing LVAD implantation, travel time was strongly associated with preoperative risk, and socioeconomic status but not postoperative outcomes or 30-d mortality. Therefore, increasing access should focus on insurance, and patient characteristics not travel time.
已有报道称，长途旅行接受手术服务对健康有不利影响。鉴于管理左心室辅助装置（LVAD）植入所需的多学科护理高度复杂，在我们州只有 18 个中心中的 4 个进行这些手术。考虑到我们获得的机会有限，我们假设增加旅行时间会对术后结果和 30 天死亡率产生不利影响。
通过查询全州胸外科医师学会数据库，确定接受 Heartmate II/III 和 HVAD 植入的患者，共确定了 725 名患者。通过邮政编码计算旅行时间。根据旅行时间的上四分位数（1 小时），将患者分为区域组和远程组。比较两组之间的术前变量和结果。进行多变量分析，以评估旅行时间在 30 天死亡率风险调整模型中的影响。
在我们州，患者前往 LVAD 中心的中位旅行时间为 32 分钟（平均 53±65 分钟，46±71 英里）。远程组（n=191）的中位收入较低，自费比例较高，患有更多的医疗合并症。尽管存在这些差异，但两组之间的 ICU 和/或住院时间、再入院率、术后并发症或 30 天死亡率没有差异。多变量回归表明，保险状况、年龄和既往手术预测 30 天死亡率，但不预测旅行时间。
尽管全州只有四个中心进行 LVAD 植入，但旅行时间与术前风险和社会经济地位密切相关，但与术后结果或 30 天死亡率无关。因此，增加手术机会应重点关注保险和患者特征，而不是旅行时间。
