Orringer Matthew, Roberts Heather, Ngan Alex, Ward Derek
School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
Arthroplast Today. 2023 May 17;21:101131. doi: 10.1016/j.artd.2023.101131. eCollection 2023 Jun.
Disparities exist in access to and outcomes following total knee arthroplasty. However, there is a paucity of data examining the relationship between travel distance and these disparities.
We used the Healthcare Cost and Utilization Project, American Hospital Association, and UnitedStatesZipCodes.org Enterprise databases to gather patient demographic and postoperative outcomes data. We calculated the distance traveled between patient population-weighted zip code centroid points and the hospitals at which they received total knee arthroplasty. We then examined the association between travel distance and patient demographic characteristics as well as postoperative adverse outcomes.
Among of cohort of 384,038 patients, white patients (16.58 miles) traveled farther on average than Black (10.05) or Hispanic patients (10.54) ( < .0001). Medicare and commercial insurance coverage were associated with greater travel distance ( < .0001). Fewer medical comorbidities ( < .001) and residence in the highest-income areas ( < .0001) were associated with increased travel distance. Differences in postoperative complication rates related to travel distance were not clinically significant.
Increased travel distance for total knee arthroplasty was associated with white race, commercial and Medicare insurance coverage, fewer medical comorbidities, and increased socioeconomic status. Future work is needed to determine the underlying causal mechanisms leading to these differences in access to specialized care.
全膝关节置换术在可及性和术后结果方面存在差异。然而，研究旅行距离与这些差异之间关系的数据很少。
我们使用了医疗保健成本与利用项目、美国医院协会和美国邮政编码组织企业数据库来收集患者人口统计学和术后结果数据。我们计算了患者人口加权邮政编码中心点与他们接受全膝关节置换术的医院之间的旅行距离。然后，我们研究了旅行距离与患者人口统计学特征以及术后不良结果之间的关联。
在384,038名患者的队列中，白人患者（平均旅行16.58英里）比黑人患者（10.05英里）或西班牙裔患者（10.54英里）平均旅行距离更远（P<0.0001）。医疗保险和商业保险覆盖与更远的旅行距离相关（P<0.0001）。较少的医疗合并症（P<0.001）和居住在最高收入地区（P<0.0001）与旅行距离增加相关。与旅行距离相关的术后并发症发生率差异在临床上不显著。
全膝关节置换术旅行距离增加与白人种族、商业和医疗保险覆盖、较少的医疗合并症以及社会经济地位提高有关。需要未来的工作来确定导致这些专科护理可及性差异的潜在因果机制。
