Distance bias and surgical outcomes

Area of Science:

• Health Services Research
• Surgical Outcomes
• Patient Travel Distance

Background:

• Previous research suggests a
• distance bias
• where patients traveling significant distances for medical care experience better outcomes.
• This study investigates distance bias in surgical treatment at a tertiary care institution.

Purpose of the Study:

• To analyze the phenomenon of distance bias in surgical patients using risk-adjusted outcomes data.
• To determine if traveling further for surgical treatment correlates with better patient outcomes.

Main Methods:

• Utilized risk-adjusted surgical outcomes data from the National Surgical Quality Improvement Project at the Mayo Clinic.
• Calculated observed versus expected risks of severe complications for surgical patients.
• Stratified patients into quintiles based on their travel distance to the institution.

Main Results:

• Patients living closest to the institution (quintile 1) had lower observed and expected risks of severe complications compared to those traveling further.
• Local patients (quintile 1) demonstrated better-than-predicted outcomes (observed:expected risk ratio of 0.82).
• Patients traveling intermediate distances (quintile 2) experienced worse-than-predicted outcomes (observed:expected risk ratio of 1.18).

Conclusions:

• The study did not find evidence of the previously documented distance bias in surgical care.
• An inverse phenomenon was observed, where patients treated locally had better outcomes and were less likely to experience severe complications.
• Local treatment may be associated with superior surgical results, contrary to the established distance bias literature.