Does travel distance influence length of stay in elective colorectal surgery?

BACKGROUND

Length of stay following elective colorectal surgery is being reported as a quality measure in surgical outcome registries, such as the National Surgical Quality Improvement Program. Regional referral centers with large geographic catchment areas attract patients from significant distances.

OBJECTIVE

The aim of this study was to examine the effect of patient distance traveled, from primary residence to a tertiary care hospital, on length of stay in elective colorectal surgery patients.

DESIGN

Retrospective population-based cohort study uses data obtained from the National Surgical Quality Improvement Program database.

SETTINGS: This study was conducted at a tertiary referral hospital.

PATIENTS: Data on 866 patients undergoing elective colorectal surgery from May 2003 to April 2011 were reviewed.

MAIN OUTCOME MEASURES: Demographics, surgery-related variables, and distance traveled were analyzed relative to the length of stay.

RESULTS

Of the 866 patients, 54% were men, mean age was 57 years, mean distance traveled was 145 miles (range, 2-2984 miles), and mean length of stay was 8.8 days. Univariate analysis showed a significant increase in length of stay with increased distance traveled (p = 0.02). Linear regression analysis revealed a significant association between increased length of stay and male sex (p = 0.006), increasing ASA score (p = 0.000), living alone (p = 0.009), and increased distance traveled (p = 0.028). For each incremental increase in log distance traveled, the length of stay increases by 2.5%.

LIMITATIONS: This is a retrospective review that uses National Surgical Quality Improvement Program data. It is not known how many patients left the hospital and did not return to their primary residence.

CONCLUSIONS

In a model that controlled for variables, increased travel distance from a patient's residence to the surgical hospital was associated with an increase in length of stay. If length of stay is a reportable quality measure in patients undergoing colorectal surgery, significant travel distance should be accounted for in the risk adjustment model calculations.