Association Between Travel Distance and Outcomes for Common Pediatric Surgical Procedures

Regionalization may improve access to specialized pediatric surgical resources but require substantial travel for common inpatient procedures. We examined associations between estimated travel distance and inpatient outcomes after common pediatric surgical operations.

We conducted a retrospective cohort study using 2018-2021 Healthcare Cost and Utilization Project State Inpatient Databases from 12 states. Children undergoing inpatient appendectomy, cholecystectomy, pyloromyotomy, inguinal hernia repair, or gastrostomy/jejunostomy placement were categorized by estimated driving distance from patient to hospital ZIP-code centroid (<30, 30-60, or >60 miles). Outcomes were complications, length of stay, and total hospital charges. Multivariable models adjusted for patient, procedure, and hospital characteristics.

Among 71,451 children, 52,498 (73.5%) lived <30 miles, 10,359 (14.5%) lived 30-60 miles, and 8,594 (12.0%) lived >60 miles from the treating hospital. Compared with <30 miles, >60 miles was associated with higher adjusted odds of complications (1.21, 95% CI 1.12-1.31), longer length of stay (1.13, 95% CI 1.10-1.15), and higher hospital charges (1.09, 95% CI 1.07-1.10). Associations attenuated after additional adjustment for state, with complications no longer statistically significant.

Greater estimated travel distance was associated with worse inpatient outcomes and higher resource utilization after common pediatric surgical procedures. Geographic access, referral patterns, hospital capability, and patient complexity may contribute to these associations, supporting selective regionalization rather than universal centralization of common pediatric surgical care.