L. H. Nicholas1, C. Wolfgang1 1Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA
Introduction: Whether to concentrate risky surgical procedures in high-volume hospitals is a long-standing question among surgeons, policy-makers and payers. Despite decades of interest in this question, little is known about the potential costs of increased patient travel.
Methods: We studied all radical pancreaticoduodenectomy inpatient admissions to hospitals that exceeded low-volume thresholds (more than 6 operations per year) among Maryland residents from 2004 – 2012 (N = 1,277). We used general linear regression models to assess the relationship between the total cost of hospitalization and distance patients traveled controlling for patient demographics, complexity and severity.
Results: Maryland residents traveled an average of 34.6 miles (median 19.5) for surgery. Admissions costs averaged $46,597 (median $36,803). Total costs were higher from patients living further from their hospitals. Compared to patients in the lowest quartile of hospital distance (who lived fewer than 8 miles from their hospital), patients in the second distance quartile (8 – 20 miles) incurred an additional $5,205 in admissions costs (p = 0.001), while those in the highest quartile (47 – 300 miles) had an additional $4,616 in total costs (p = 0.055).
Conclusion: Greater patient travel distance was associated with increased costs for pancreaticoduodenectomy. Patients traveling to high-volume centers may require duplicative testing if they initiated care elsewhere and longer stays before they can return home. These costs should be accounted for in payer and policy-maker decisions about regionalizing surgical procedures.