Geographic access to care and pediatric surgical outcomes

Area of Science:

• Pediatric Surgery
• Health Services Research
• Rural Health

Background:

• Rurality and travel distance are linked to poorer pediatric health outcomes.
• Geographic barriers can disproportionately affect patient care and surgical results.

Purpose of the Study:

• To investigate the association between rurality, travel time, and postoperative outcomes in pediatric surgical patients.
• To identify disparities in surgical outcomes based on geographic factors.

Main Methods:

• Retrospective analysis of pediatric patients (0-21 years) treated at a quaternary pediatric surgical facility (2016-2020).
• Categorization of patients by metropolitan or non-metropolitan addresses and proximity (60- and 120-min driving rings).
• Logistic regression used to assess the impact of rurality and travel distance on postoperative mortality and serious adverse events (SAE).

Main Results:

• Patients traveling over 120 minutes had significantly increased odds of mortality (59%) and SAE (97%) compared to those within 60 minutes.
• Non-metropolitan patients faced a 38% higher likelihood of serious postoperative events compared to metropolitan patients.
• Analysis included 56,655 patients, with 8.4% from non-metropolitan areas.

Conclusions:

• Rurality and extended travel distances are associated with worse pediatric surgical outcomes.
• Targeted efforts to enhance geographic access are necessary to address inequities in pediatric surgical care.
• Reducing travel time and improving access for rural pediatric populations can mitigate adverse surgical events.