Differences in Baseline Demographic Characteristic and Complexity of Patients Based on Distance Traveled to Academic
Corinne Vennitti1, John Burke1, Shivam Gandhi1
1Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.
Background:
Many patients undergoing total hip (THA) or knee arthroplasty (TKA) require specialty surgical care. Therefore, referral to tertiary academic medical centers may increase, but may predispose for worse outcomes. This work sought to assess baseline characteristics as well as 90-day and 1-year complication rates for patients based on the distance traveled for surgery.
Methods:
A retrospective review of patients who underwent primary THA or TKA at a tertiary care center between 2017 and 2020 was completed. Patients who underwent arthroplasty for fracture, revision arthroplasty, or lacked appropriate follow-up were excluded. Patient zipcode and address was used to calculate the area deprivation index (ADI) and distance to surgery. Ninety-day and 1-year complications (emergency department visit, readmission, venous thromboembolism, infection, reoperation, myocardial infarction, stroke, and mortality) were assessed for distance traveled.
Results:
The cohort was 500 patients (219 THA, 281 TKA). The average age was 65 years old with 58% women and 42% men. The average state ADI was 5.5 and national ADI was 41, which is approximately the average state and national percentile. The average distance to surgery was 47 miles. No statistically significant difference was found between distance traveled or ADI and postoperative outcomes. Patients who traveled >50 miles generally were younger, uninsured, had a higher ADI, and had a primary diagnosis other than osteoarthritis.
Conclusions:
The study supports and reflects prior literature demonstrating there is no statistically significant increase in the 90-day and 1-year complication rates based on ADI or distance traveled to surgery.