The relationship of travel distance with cystectomy access and outcomes

Regionalization of care and travel distance may result in unintended consequences for complex surgery such as cystectomy. Our objective was to evaluate effect of differential distance on cystectomy receipt among patients with muscle-invasive bladder cancer (MIBC) and investigate the association between travel distance and cystectomy outcomes such as readmission.

Using a linked data resource combining the NC Central Cancer Registry with claims data from Medicare, Medicaid, and private insurance plans, we included 736 patients with MIBC and 1,082 who underwent cystectomy. To evaluate access, differential distance was calculated as the difference between the nearest urologist and nearest cystectomy provider. To assess outcomes, logistic regression was used to evaluate rehospitalization and major complications, and Cox proportional hazards model for survival analysis.

To evaluate access and outcomes, 736 patients with MIBC and 1,082 patients undergoing cystectomy were evaluated, respectively. Overall, 29% (211 of 736) with MIBC underwent cystectomy. Differential distance was not a predictor of cystectomy receipt (odds ratio = 1.0; 95% CI: 1.00, 1.01). Among patients undergoing cystectomy, travel distance from cystectomy provider was not a significant predictor of 30- or 31 to 90day readmissions (odds ratio = 1.0; 95% CI: 1.00, 1.00) although patients who lived further from their cystectomy provider were more likely to be readmitted to a nonindex hospital (P<0.001) when controlling for other factors. Although travel distance did not have a significant effect on overall survival, patients readmitted between 31 to 90days had worse overall survival (P<0.0001).

The additional distance needed to reach a cystectomy provider did not predict receipt of surgery for MIBC. Furthermore, travel distance from cystectomy provider was not a significant predictor for subsequent readmission after cystectomy and did not affect overall survival.

Urologic oncology. 2018 Mar 19 [Epub ahead of print]

Angela B Smith, Anne-Marie Meyer, Ke Meng, Matthew E Nielsen, Raj Pruthi, Eric Wallen, Michael Woods, Hung-Jui Tan

Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Urology, Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC. Electronic address: ., Department of Urology, Lineberger Comprehensive Cancer Center, Integrated Cancer Information and Surveillance System, University of North Carolina at Chapel Hill, Chapel Hill, NC., Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Urology, Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC; Departments of Epidemiology and Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC., Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Urology, Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC.

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