IMPACT OF ELECTIVE OPEN AAA REPAIR VOLUME CUTOFFS ON PATIENT ACCESS TO SURGICAL CARE IN NEW YORK STATE.

Objectives: Volume-outcome relationships have established improved outcomes for patients undergoing open AAA repair if performed by surgeons with a yearly volume of ≥7 open aortic procedures and at hospitals with a perioperative mortality rate of <5%. However, the impact of this recommendation on patients' driving distance and access to surgery is unknown. This study seeks to quantify the impact on patients' access to care in such high-volume centers.

Methods: Patients undergoing elective open AAA repair were identified using the New York SPARCS database from 2003 to 2014. An average of 7 open aortic repairs per year was considered high-volume. Travel distances to hospitals were obtained using patient addresses via Google Distance Matrix and compared before and after surgeon and hospital standards were implemented. Patient addresses were stratified as urban or rural based on USDA Rural-Urban Commuting Area cutoffs. Comparisons were performed using both geospatial data analysis by county and Mann-Whitney U-test.

Results: 6,337 patients who underwent open AAA had identifiable addresses for which distances to their surgical center could be obtained. Only 2,077 (32.8%) patients were treated by surgeons and at centers that met previously proposed criteria. If recommended guidelines were implemented, the travel distances would change from 8.1 (IQR:3.7-15.3) to 11.1 (IQR:6.2-18.5) miles (p<0.001) for patients in urban locations (n=3024). For patients who live in rural locations (n=1236) the travel distances would change from 31.3(IQR:12.8-52.3) to 39.4 (IQR:23.2-61.1) (p<0.001) (Figure 1).

Conclusions: These data show that travel times would increase for open AAA patients should volume guidelines be implemented. Alternative solutions, such as allowing lower volume surgeons who operate at centers with high volume surgeons, should be considered to increase patient access to care.