ArticleJournal of cardiac surgery2019
Travel distance and regional access to cardiac valve surgery.
Article in Journal of cardiac surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
5 citing papers in PubMed.
- Willingness of Older Adults to Travel for Medical Care.JAMA network open · 2026Article
- Cardiac Surgery to Manage Rheumatic Heart Disease in Africa Is Complex - a Geographic Perspective.Global heart · 2025Article
- Travel distance and outcomes after surgical aortic valve among veterans.Health services research · 2024Article
- Evaluating Distance Bias in Chronic Rhinosinusitis Outcomes.JAMA otolaryngology-- head & neck surgery · 2022Article
- Economic Analysis and Long-term Follow-up of Distant Referral for Degenerative Mitral Valve Repair.The Annals of thoracic surgery · 2021Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveEvidence in other surgical subspecialties suggests patients traveling farther to undergo surgery have worse outcomes. We sought to determine the impact of travel distance and travel beyond closest center on outcomes after valve surgery.
methodsPatients who underwent valve surgery ±CABG with a Society of Thoracic Surgeons (STS) predicted risk and zip code were extracted from a statewide STS database (2011-016). Patients were stratified by those receiving care greater than or equal to 20 miles from the closest surgical center (Traveler) or at the closest center (Non-Traveler). Multivariate logistic regression assessed the effects of travel distance and traveler status on mortality and major morbidity adjusted for STS predicted risk, median income by zip code, and payer status.
resultsMedian travel distance for all patients (n = 4765) was 19 miles and after risk-adjustment increasing distance was associated with reduced operative mortality (odds ratio [OR], 0.94 [0.89-1.00], P = .049) with no impact on major morbidity. Travelers (445 patients, 9.3%) had lower median income, higher self-pay and reoperative status, but similar urgent/emergent status and STS risk as Non-Travelers. Travelers had lower operative mortality (1.6% vs 4.3%, P = .005) which remained statistically lower after risk-adjustment (OR, 0.32 [0.14-0.75], P = .009). This mortality difference was particularly pronounced in patients with postoperative complications (3.1% vs 7.9%, P = .005).
conclusionsContrary to other surgical subspecialties, farther travel distance and bypassing the nearest surgical center were associated with lower rates of operative mortality and failure to rescue. Either referral patterns or financials reasons may result in Travelers ending up at high performing centers that prevent escalation of complications.
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