Travel distance may not impact 90-day outcomes, complications after THA
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Key takeaways:
- Travel may not impact patient-reported outcomes or complications after total hip arthroplasty.
- Patients who traveled 40 miles or more had similar outcomes vs. patients who traveled fewer than 40 miles.
According to published results, patients who traveled 40 miles or more to undergo total hip arthroplasty had similar 90-day outcomes and complication rates compared with patients who traveled fewer than 40 miles for surgery.
Conor M. Jones, MD, and colleagues from the department of orthopedic surgery at Rush University Medical Center performed a retrospective study of data from 413 patients who underwent inpatient, primary THA at a single center between April 2017 and March 2021.
According to the study, Jones and colleagues classified patients who traveled 40 miles or more for surgery (n = 96) as “travelers” and patients who traveled fewer than 40 miles for surgery (n = 317) as “locals.” Mean driving distance was 96.1 miles (range, 40.1 to 678 miles) for travelers and 14.1 miles for locals (range, 0.3 miles to 39.8 miles).
Postoperative outcome measures included Veterans Rand 12-item health survey (VR-12), Hip Harris Score (HHS), Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), complications, ED visits, readmissions and reoperations at a minimum follow-up of 90 days.
Overall, Jones and colleagues found no significant differences in postoperative VR-12, HHS or HOOS JR scores between travelers and locals. They also found no significant differences in the percentage of patients who achieved the minimal clinically important difference for VR-12, HHS and HOOS JR scores between travelers and locals.
At 90 days, rates of complications, readmissions and reoperations were similar between travelers and locals. However, Jones and colleagues noted locals had a significantly higher rate of unplanned ED visits compared with travelers (7.3% vs. 0%).
“THAs are increasingly being performed at high-volume centers, causing some patients to travel further distances to receive care,” Jones and colleagues wrote in the study.
“These data suggest that increased travel distance to treatment centers does not markedly impact outcomes following primary THA,” they concluded.
Perspective
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This was an interesting retrospective study that examined the effect of traveling a distance of greater than (“travelers”) or less than (“locals”) 40 miles for total hip arthroplasty and/or follow-up on patient-reported outcomes (PROs) and 90-day complications at a center of excellence. The two cohorts did not differ significantly in terms of preoperative demographics, with the exception of travelers having had lower average Harris Hip Scores. There were no differences in postoperative PROs, complications, readmissions or reoperations. Locals did visit the ED significantly more than travelers.
The limitations of this study, other than its retrospective design, include the selection criterion of miles vs. minutes. In an urban area, it can take just as long to travel 14 miles as it does a rural patient to travel 40 miles depending on traffic density and mode of transportation. It is not known if differences in access to EDs and other unidentified social determinants of health in the two populations could have affected the outcomes. One also wonders how recent health policy changes requiring PRO collection at 1 year for CMS inpatients will affect center of excellence reimbursement for care of travelers who might not have access to the same level of care locally.
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