The Effects of Travel Burden on Outcomes After Resection of Extrahepatic Biliary Malignancies: Results from the US Extrahepatic Biliary Consortium. J Gastrointest Surg 2017 Dec;21(12):2016-2024
Date
10/08/2017Pubmed ID
28986752Pubmed Central ID
PMC5909109DOI
10.1007/s11605-017-3537-4Scopus ID
2-s2.0-85030684354 (requires institutional sign-in at Scopus site) 22 CitationsAbstract
BACKGROUND: Surgical resection of extrahepatic biliary malignancies has been increasingly centralized at high-volume tertiary care centers. While this has improved outcomes overall, increased travel burden has been associated with worse survival for many other malignancies. We hypothesized that longer travel distances are associated with worse outcomes for these patients as well.
STUDY DESIGN: Data was analyzed from the US Extrahepatic Biliary Consortium database, which retrospectively reviewed patients who received resection of extrahepatic biliary malignancies at 10 high-volume centers. Driving distance to the patient's treatment center was measured for 1025 patients. These were divided into four quartiles for analysis: < 24.5, 24.5-57.2, 57.2-117, and < 117 mi. Cox proportional hazard models were then used to measure differences in overall survival.
RESULTS: No difference was found between the groups in severity of disease or post-operative complications. The median overall survival in each quartile was as follows: 1st = 1.91, 2nd = 1.60, 3rd = 1.30, and 4th = 1.39 years. Patients in the 3rd and 4th quartile had a significantly lower median household income (p = 0.0001) and a greater proportion Caucasian race (p = 0.0001). However, neither of these was independently associated with overall survival. The two furthest quartiles were found to have decreased overall survival (HR = 1.39, CI = 1.12-1.73 and HR = 1.3, CI = 1.04-1.62), with quartile 3 remaining significant after multivariate analysis (HR = 1.45, CI = 1.04-2.0, p = 0.028).
CONCLUSIONS: Longer travel distances were associated with decreased overall survival, especially in the 3rd quartile of our study. Patients traveling longer distances also had a lower household income, suggesting that these patients have significant barriers to care.
Author List
O'Connor SC, Mogal H, Russell G, Ethun C, Fields RC, Jin L, Hatzaras I, Vitiello G, Idrees K, Isom CA, Martin R, Scoggins C, Pawlik TM, Schmidt C, Poultsides G, Tran TB, Weber S, Salem A, Maithel S, Shen PMESH terms used to index this publication - Major topics in bold
AgedBiliary Tract Neoplasms
Delivery of Health Care
Female
Hospitals, High-Volume
Humans
Income
Male
Middle Aged
Proportional Hazards Models
Retrospective Studies
Survival Rate
Tertiary Care Centers
Travel
Treatment Outcome
United States
