Travel distance and outcomes after surgical aortic valve among veterans

IF 3.1 2区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Services Research Pub Date : 2024-03-13 DOI:10.1111/1475-6773.14296

Brendin R. Beaulieu-Jones MD, MBA, MBI, Noah Siegel BS, Loreski Collado MD, Hillary J. Mull PhD, MPP, Jacquelyn A. Quin MD, MPH

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引用次数: 0

Abstract

Objective

To investigate the association between travel distance and postoperative length of stay (LOS) and discharge disposition among veterans undergoing surgical aortic valve replacement (SAVR).

Data Sources/Study Setting

We performed a retrospective cohort study of patients undergoing SAVR, with or without coronary artery bypass grafting (CABG) at VA Boston Healthcare (January 1, 2005–December 31, 2015).

Study Design

Postoperative LOS and discharge disposition were compared for SAVR patients based on travel distance to the facility: <100 miles or ≥100 miles. Multivariable regression was performed to ascertain factors associated with LOS and home discharge.

Data Collection/Extraction Methods

Data were collected via chart review. All patients undergoing SAVR at our institution who primarily resided within the defined region were included.

Principal Findings

Of 597 patients studied, 327 patients underwent isolated SAVR; 270 patients underwent SAVR/CABG. Overall median (IQR) distance between the patient's residence and the hospital was 49.95 miles (27.41–129.94 miles); 190 patients (32%) resided further than 100 miles away. There were no differences in the proportion of patients with diabetes, hypertension, chronic obstructive pulmonary disease (COPD), cerebrovascular disease, atrial fibrillation, or prior myocardial infarction between groups. Overall LOS (IQR) was 9 (7–13) days and did not differ between groups (p = 0.18). The proportion of patients discharged home was higher among patients who resided more than 100 miles from the hospital (71% vs. 58%, p = 0.01). On multivariable analysis, residing further than 100 miles from the hospital was independently associated with home discharge (OR = 1.64, 95% CI: 1.09–2.48). Travel distance was not associated with LOS.

Conclusions

Based on our institutional experience, potential concerns of longer hospital stay or discharge to other inpatient facilities for geographically distanced patients undergoing SAVR do not appear supported. Continued examination of the drivers underlying the marked shift of veterans to the private sector appears warranted.

查看原文本刊更多论文

退伍军人主动脉瓣手术后的旅行距离和效果。

目的调查接受主动脉瓣置换术（SAVR）的退伍军人的旅行距离与术后住院时间（LOS）和出院处置之间的关系：我们对在退伍军人波士顿医疗中心（2005 年 1 月 1 日至 2015 年 12 月 31 日）接受主动脉瓣置换术（SAVR）的患者进行了回顾性队列研究，无论患者是否接受了冠状动脉旁路移植术（CABG）：研究设计：根据到医疗机构的旅行距离，比较 SAVR 患者的术后 LOS 和出院处置：数据收集/提取方法：数据通过病历审查收集。所有在本院接受SAVR手术且主要居住在规定区域内的患者均被纳入研究范围：在接受研究的 597 名患者中，327 名患者接受了单独的 SAVR；270 名患者接受了 SAVR/CABG。患者居住地与医院之间的总距离中位数（IQR）为49.95英里（27.41-129.94英里）；190名患者（32%）居住地距离医院超过100英里。糖尿病、高血压、慢性阻塞性肺病 (COPD)、脑血管疾病、心房颤动或既往心肌梗死患者的比例在各组之间没有差异。总住院日（IQR）为 9 (7-13) 天，组间无差异（P = 0.18）。居住地距离医院 100 英里以上的患者出院回家的比例更高（71% 对 58%，P = 0.01）。在多变量分析中，居住地距离医院超过 100 英里与出院回家独立相关（OR = 1.64，95% CI：1.09-2.48）。旅行距离与 LOS 无关：根据我们医院的经验，地理位置较远的 SAVR 患者住院时间较长或出院后转至其他住院机构的潜在担忧似乎并不成立。我们认为有必要继续研究退伍军人明显转向私人医疗机构的根本原因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Services Research 医学-卫生保健

CiteScore

4.80

自引率

5.90%

发文量

193

审稿时长

4-8 weeks

期刊介绍： Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.