Increased Distance From the Tertiary Cardiac Center Is Associated With Worse 30-Day Outcomes After Cardiac Operations

Côté, Claudia L.; Singh, Subhash C.; Yip, Alexandra M.; Murray, Joshua; MacLeod, J.B.; Lutchmedial, Sohrab; Brown, Craig; Forgie, R.; Pelletier, Marc; Hassan, Ansar

doi:10.1016/j.athoracsur.2015.05.058

Cited by 21 publications

(12 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is also supported by a study investigating the relationship between distance and outcome after cardiac operations. 24 The outcome was significantly worse in patients living beyond 100 km from the hospital, which is a much larger distance than analyzed in our study.…”

Section: Discussioncontrasting

confidence: 46%

Effect of distance to specialist care for the diagnosis and disease outcome of inflammatory bowel disease in the Swiss inflammatory bowel disease cohort study

Grob

Bluemel

Biedermann

et al. 2020

Therap Adv Gastroenterol

View full text Add to dashboard Cite

Background: Inflammatory bowel disease (IBD) needs early interventions and an individual specialist–patient relationship. Distance from a tertiary IBD center might affect patient’s disease course and outcome. We investigated whether the patient-to-specialist distance has an impact on the disease course using the well-defined patient collective of the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS). Methods: Patient’s home address at diagnosis (postal zip code) was extracted from the SIBDCS database. Distance between each zip code and the nearest located IBD specialist center was calculated and classified into the following three sections based on proximity: <10 km (group 1); 10–35 km (group 2); >35 km (group 3). Results: Our study included in total 408 IBD patients [234 Crohn’s disease (CD), 154 ulcerative colitis (UC), 20 IBD unclassified (IBDU)]. Median age was lowest in group 2 at diagnosis (G1: 28 years; G2: 21 years, G3: 26 years, p < 0.01). The diagnostic delay did not differ between groups. CD patients in group 1 were treated more often with anti-tumor necrosis factor (TNF) agents (72% versus 56%, p = 0.04) and 5-aminosalicylates (44% versus 28%, p = 0.04) than in group 3. UC/IBDU patients in group 1 were treated more often with corticosteroids than patients in group 3 (83% versus 58%, p < 0.01). The occurrence of IBD-related surgeries did not differ between groups. Conclusions: Patient-to-specialist distance might affect drug treatment. However, disease course and the need for IBD-related surgery does not seem to be associated with a longer distance to specialist care in Switzerland.

show abstract

Section: Discussioncontrasting

confidence: 46%

Effect of distance to specialist care for the diagnosis and disease outcome of inflammatory bowel disease in the Swiss inflammatory bowel disease cohort study

Grob

Bluemel

Biedermann

et al. 2020

Therap Adv Gastroenterol

View full text Add to dashboard Cite

show abstract

“…The community level association with surgical outcomes demonstrated in the present study is likely multifactorial including access to care, hospital quality and community health resources. Several studies of access to surgical care focus on patient travel distance as a surrogate however a more important factor is timing to diagnosis, referral and surgical treatment 13 29–32. Insurance status has repeatedly been reported as one of the most important factors affecting a patients’ access to surgical care 33–35.…”

Section: Discussionmentioning

confidence: 99%

Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

et al. 2019

View full text Add to dashboard Cite

BackgroundSocioeconomic status affects surgical outcomes, however these factors are not included in clinical quality improvement data and risk models. We performed a prospective registry analysis to determine if the Distressed Communities Index (DCI), a composite socioeconomic ranking by zip code, could predict risk-adjusted surgical outcomes and resource utilisation.MethodsAll patients undergoing surgery (n=44,451) in a regional quality improvement database (American College of Surgeons-National Surgical Quality Improvement Program ACS-NSQIP) were paired with DCI, ranging from 0–100 (low to high distress) and accounting for unemployment, education level, poverty rate, median income, business growth and housing vacancies. The top quartile of distress was compared to the remainder of the cohort and a mixed effects modeling evaluated ACS-NSQIP risk-adjusted association between DCI and the primary outcomes of surgical complications and resource utilisation.ResultsA total of 9369 (21.1%) patients came from severely distressed communities (DCI >75), who had higher rates of most medical comorbidities as well as transfer status (8.4% vs 4.8%, p<0.0001) resulting in higher ACS-NSQIP predicted risk of any complication (8.0% vs 7.1%, p<0.0001). Patients from severely distressed communities had increased 30-day mortality (1.8% vs 1.4%, p=0.01), postoperative complications (9.8% vs 8.5%, p<0.0001), hospital readmission (7.7 vs 6.8, p<0.0001) and resource utilisation. DCI was independently associated with postoperative complications (OR 1.07, 95% CI 1.04 to 1.10, p<0.0001) as well as resource utilisation after adjusting for ACS-NSQIP predicted riskConclusionIncreasing Distressed Communities Index is associated with increased postoperative complications and resource utilisation even after ACS-NSQIP risk adjustment. These findings demonstrate a disparity in surgical outcomes based on community level socioeconomic factors, highlighting the continued need for public health innovation and policy initiatives.

show abstract

“…Geographic distance from the primary surgical center has been demonstrated to influence outcomes in patients with congenital heart disease both before and after surgical repair, as well as adults following cardiac surgery. [5][6][7] Patient proximity to their medical center has also been shown to be a risk factor for medication nonadherence, 8 which may play a crucial role in outcomes following transplantation. Adult data suggest that geographic distance from transplant center does not negatively impact outcomes following heart transplantation 9 ; however, the impact of distance on pediatric heart transplant outcomes has not been well defined.…”

Section: Introductionmentioning

confidence: 99%

Geographic Distance From Transplant Center Does Not Impact Pediatric Heart Transplant Outcomes

et al. 2018

View full text Add to dashboard Cite

show abstract

Increased Distance From the Tertiary Cardiac Center Is Associated With Worse 30-Day Outcomes After Cardiac Operations

Cited by 21 publications

References 14 publications

Effect of distance to specialist care for the diagnosis and disease outcome of inflammatory bowel disease in the Swiss inflammatory bowel disease cohort study

Effect of distance to specialist care for the diagnosis and disease outcome of inflammatory bowel disease in the Swiss inflammatory bowel disease cohort study

Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

Geographic Distance From Transplant Center Does Not Impact Pediatric Heart Transplant Outcomes

Contact Info

Product

Resources

About