ACS 2018: Extra-Regional Travel for Urologic Surgery: Opportunities for Improving Access

Boston, Massachusetts ( Bradley D. Figler presented a review and their assessment of extra-regional travel (ERT) for surgery as an indicator of low access to urologic surgery. They analyzed inpatient and ambulatory urologic surgeries for patients ≥18 years old in the 2010-2014 Florida (FL) and North Carolina (NC) ambulatory/inpatient surgery databases, capturing 100% of ambulatory and inpatient procedures.

Primary outcome was ERT, defined as surgery outside of the patient's Health Referral Region. Rates of ERT were compared for urolithiaiss (UL), benign prostatic hypertrophy (BPH), cancer (CA), male reconstruction (MR), and female reconstruction (FR). High travel regions were defined as ERT in ≥50% of encounters for ≥2 surgery types.

Their analysis included 480,060 surgeries: UL (239,400), FR (101,160), BPH (66,282), CA (50,834), MR (22,384). Rates of ERT were highest for CA and MR (22% for each), compared to 12% for FR, 9% for UL and 8% for BPH. Younger age, private insurance, and white race were associated with ERT across all surgery types. Regionally, percent poverty (OR 1.14, 95% CI 1.1 - 1.2) and percent rural (OR 1.02, 95% CI 1.01 - 1.03) were associated with high travel region.

They concluded CA and MR surgery were associated with high rates of ERT. Rural and poor regions are associated with high ERT across multiple surgery types. Efforts to improve access to urologic surgery should focus on CA and MR surgery in poor and rural regions. Understanding the variation using multilevel modeling will confirm and elucidate these findings to understands mechanisms to improve access to care and outcomes.

Presented by: Bradley D. Figler, University of North Carolina School of Medicine, Chapel Hill, NC, 

Written by: Stephen B. Williams, MD., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, MD. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 2018 American College of Surgeons Clinical Congress, October 21-25, 2018 in Boston, Massachusetts