Medical Student University of Kansas School of Medicine Kansas City, Kansas, United States
Introduction: Long driving distances to treatment facility influence patient outcomes according to previous reports in the literature. The aim of this study is to report on the impact that driving distance has on perioperative outcomes for patient undergoing spine instrumented fusion.
Methods: A retrospective review of patients undergoing instrumented spine fusion with use of navigation from 2013 to 2022 was conducted. Patient address was used to calculate fastest driving distance to treatment facility. Three different locations were included in the study. Length of driving distance in miles was compared to determine effects on recorded outcomes measures.
Results: A total of 978 patients were included in the study. Distance less than 50 miles accounted for (62.4%) of patients, 50-100 miles (18.3%), 100-150 miles (8.5%), and greater than 150 miles (10.6%). Driving distance was associated with a statistically significant increase in length of stay (p=.011), number of levels fused (p=.008), and a higher rate of loss to follow up (p=.032). Patients driving over 50 miles were more likely to get fused following trauma, whereas patients traveling less than 50 miles more often had degenerative indications for surgery (p=.002). Additionally, driving distance over 50 miles was associated with less scheduled hospital admission and more presentation through the emergency department (ED) or transfer. No difference was noted in in ODI (p=.279), pain score change (p=.556), length of follow up (p=.376), or morphine milligram equivalents (MME) prescription(p=.894). Furthermore, driving distance had no statistical impact on complication rates.
Conclusion : Driving distance from facility of treatment was associated with a higher number of levels fused. Additionally, even when controlling for number of levels fused, patients who drove further stayed in the hospital longer postoperatively and were more likely to be lost to follow up. Acuity of indication for surgery had an impact on travel distance: patients with traumatic injuries are more likely to travel greater distances to receive care and often present through transfer or the ED. The distance that patients must travel to get treatment can be used to identify patient at high risk of certain perioperative outcomes.
