Association Between Patient Travel Time and Postoperative Complications in a Broad Surgical Population

Surgery requires dedicated pre-, intra-, and post-operative care. The distance traveled by patients to undergo surgery may affect this care, impacting postoperative outcomes. We aimed to determine whether longer travel time is associated with increased rates of postoperative complications in a broad surgical population.

This was a retrospective analysis of one health care system's American College of Surgeons National Surgical Quality Improvement Program data, 2012-2018. Patient addresses were used to calculate driving time to their surgical center using Google Maps. Patients were grouped into local (≤1 h) and distant (>1 h) travel cohorts. Unadjusted and risk-adjusted outcomes were compared using multiple logistic regression with outcomes as the dependent variables and travel cohort and the 28 nonlaboratory preoperative National Surgical Quality Improvement Program variables as independent variables.

Of 34,525 patients, 18.0% were in the distant travel cohort, were older, had higher rates for 13 of 18 comorbidities, higher American Society of Anesthesiologists class, were more functionally dependent, and more frequently underwent inpatient and more complex surgery. These patients had higher unadjusted rates of overall morbidity, respiratory complications, infections, urinary tract infections, cardiac complications, strokes, bleeding complications, unplanned readmissions, nonhome discharge, and longer length of stay (all P < 0.05). After risk adjustment, overall morbidity, bleeding complications requiring transfusion, and length of stay remained significantly higher in patients traveling longer, while venous thromboembolism and nonhome discharge were significantly lower.

After risk adjustment, longer patient travel was associated with slightly higher overall postoperative morbidity, bleeding complications, and longer length of stay in a broad surgical population. The increases were modest but can be a burden for individual patients and their families.