Far From Home: The Role of Travel Distance and Care Fragmentation in Surgical Outcomes for Inflammatory Bowel Disease

Crohn's & Colitis 360 · 6 authors, 7 centres

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TL;DR

Integrated preoperative care was not significantly associated with a lower complication rate overall.

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The primary outcome was a composite of postoperative complications. The study compared complication rates based on travel distance (>75 vs. ≤75 miles) and integrated preoperative care (receiving IBD medical management at the same institution as surgery). Bivariate analysis showed complications were significantly more common in patients with travel distance >75 miles (47.6% vs. 27.4%, P = .012). Multivariable analysis confirmed that a travel distance >75 miles was independently associated with complications. Integrated preoperative care was not statistically significant on bivariate or multivariable analysis, though an exploratory subgroup analysis suggested a stronger association among patients living closer to the center. Limitations include the single-center, retrospective design, potential unmeasured confounding, and a sample size underpowered to detect a significant effect for integrated care. The authors conclude that longer travel distance is a significant independent risk factor for surgical complications and that benefits of integrated care models may be limited for remote patients without accommodations.

STUDY TYPE

cohort

SPECIALTY

gastroenterology

SUMMARISED BY

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100% · A

ORIGINAL PAPER

PMC10066839

Far From Home: The Role of Travel Distance and Care Fragmentation in Surgical Outcomes for Inflammatory Bowel Disease

Crohn's & Colitis 360

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ABSTRACT

Abstract Background Fragmented care for inflammatory bowel disease (IBD) is known to correlate negatively with outcomes, but it is unclear which aspects of care fragmentation are relevant and potentially modifiable. Furthermore, there is little data on the relationship between travel distance and the benefits of integrated care models. Hypothesizing care coordination in the preoperative period may have a significant impact on surgical outcomes, we explored associations between integrated care, travel distance, and surgical outcomes. Methods A single-center retrospective cohort study of patients undergoing index abdominal surgery was done to compare the rate of surgical complications with and without long travel distance and nonintegrated preoperative care. Multivariable logistic regression was used to identify factors independently associated with complications. Results One hundred and fifty-seven patients were included. Complications were more common among patients with travel distance >75 miles (47.6% vs 27.4%, P = .012). Integrated preoperative care was not significant on bivariate ( P = .381) or multivariable analysis but had a stronger association among patients with travel distance <75 miles (20.9% integrated vs 36.7%, P = .138). After adjustment, new ileostomy, open surgical approach, and distance >75 miles were independently associated with complications. Conclusions Patients with longer travel distances to the hospital were twice as likely to have a surgical complication after adjusting for other risk factors. Without significant accommodations for remote patients, potential benefits of an integrated model for IBD care may be limited to patients who live close to the medical center. Future efforts addressing continuity of care should consider tactics to mitigate the impact of travel distance on outcomes.

CITATION EXPORT

Alexander Booth, Henry Colorado, Gayenell Magwood et al.. Far From Home: The Role of Travel Distance and Care Fragmentation in Surgical Outcomes for Inflammatory Bowel Disease. Crohn's & Colitis 360. (2023). https://doi.org/10.1093/crocol/otad015

AUTHORS

6 · 7 CENTRES

Alexander Booth, Henry Colorado, Gayenell Magwood, Erin Forster, Robert N Axon, Thomas Curran

Division of Colon and Rectal Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA
Division of Colon and Rectal Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
Division of Gastroenterology, Hepatology and Nutrition, Medical University of South Carolina, Charleston, South Carolina, USA
Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA
Division of Colon and Rectal Surgery, Medical University of South Carolina, Charleston, South Carolina, USA