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How far We Go For Surgery: Distance to Pediatric Surgical Care in Indiana
Cassandra Anderson1, Ben Duggan2, Cameron Colgate3
1Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA; Section of Pediatric Surgery, Riley Hospital for Children, 705 Riley Hospital Drive RI2500, Indianapolis, IN, 46202, USA.
Insights
Pediatric patients requiring specialized surgeries like pyloromyotomy and video-assisted thoracic surgery (VATS) travel farther. Younger children also face longer travel distances for essential pediatric surgical care.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Geographic Access to Care
Background:
- Access to pediatric surgical care is limited in non-academic and rural areas, despite program growth.
- Characterizing factors influencing travel distance is crucial for improving care access.
Purpose of the Study:
- To identify demographic and patient factors associated with travel distance for specific pediatric surgical procedures in Indiana.
- To understand the impact of procedure type and patient age on geographic access to pediatric surgical services.
Main Methods:
- Retrospective review of 6835 pediatric patients undergoing appendectomy, cholecystectomy, umbilical hernia repair, pyloromyotomy, and VATS from 2019-2021.
- Travel distance calculated using driving distance between patient and hospital ZIP codes.
- Multivariable linear regression used to identify factors affecting travel distance.
Main Results:
- Half of operations (46%) occurred at centers with fellowship-trained pediatric surgeons.
- Median travel distance was 13 miles; shortest for appendectomy (9 miles), longest for pyloromyotomy (51 miles) and VATS (57 miles).
- Younger age and more specialized procedures (pyloromyotomy, VATS) significantly increased travel distance (p < 0.001).
Conclusions:
- Younger age and specialized procedures correlate with increased travel distances for pediatric surgery.
- These findings indicate a regionalization of complex pediatric surgeries to urban centers.
- Strategies are needed to address disparities in access to pediatric surgical care, particularly for younger patients and those requiring specialized procedures.
Introduction:
Despite increasing numbers of pediatric surgery training programs, access to pediatric surgical care remains limited in non-academic and rural settings. We aimed to characterize demographic and patient factors associated with increased distance to selected pediatric surgical procedures in Indiana.
Methods:
This IRB-approved retrospective review analyzed pediatric patients undergoing appendectomy, cholecystectomy, umbilical hernia repair, pyloromyotomy, and video assisted thoracic surgery (VATS) procedures from 2019 through 2021. Data was obtained from an electronic medical record warehouse and the Indiana Hospital Association. Travel distance was calculated as driving distance between patient address and hospital ZIP codes. Statistics were performed in R, with p < 0.05 indicating significance.
Results:
There were 6835 operations performed, and half of all operations (46%) were performed at institutions with fellowship-trained pediatric surgeons. The median travel distance for all operations was 13 miles (range 0-182); the shortest was for laparoscopic appendectomy (9 miles, IQR[0-20]). The longest distances were for pyloromyotomy (51 miles, IQR[14-84]) and VATS procedures (57 miles, IQR[13-111]), of which, nearly all were performed at tertiary pediatric care centers (97% and 93%, respectively). There was a significant linear and quadratic effect of age on travel distance (p < 0.001), with younger patients requiring farther travel. On multivariable linear regression, age and procedure type had the largest effect on travel distance (Eta squared 0.03, p < 0.001).
Conclusion:
Younger age and more specialized procedures, including VATS and pyloromyotomy, were associated with increased travel distance. This highlights regionalization of these procedures to urban areas with pediatric care centers, while others are performed closer to home.
Level Of Evidence:
III TYPE OF STUDY: Retrospective comparative study.
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