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Canadian Journal of Cardiology

Increased Travel Time to the Tertiary Centre Is Associated With Decreased Long-term Survival Following Ascending Aortic Operations

Published:February 10, 2022DOI:https://doi.org/10.1016/j.cjca.2022.02.006

      Abstract

      Background

      The association between travel time from tertiary care centre and outcomes after ascending thoracic aortic surgery is unknown. We determined the effect of travel time from the tertiary care centre on outcomes in ascending aortic repair in Nova Scotia.

      Methods

      A retrospective analysis of patients undergoing elective and emergent ascending thoracic aortic operations from 2005 to 2015 was carried out. Patient’s residential geographic coordinates were used to calculate travel time to the tertiary care centre, and patients who resided < 1 hour vs ≥ 1 hour were compared. Multivariable logistic regression was performed to determine the effect of travel time on in-hospital outcomes. Cox-proportional hazard modelling and Kaplan-Meier survival estimates were created to determine the effect on long-term survival.

      Results

      A total of 476 patients underwent ascending thoracic aortic surgery from 2005 to 2015. Patients who resided < 1 hour from the tertiary care centre vs patients who resided ≥ 1 hour had similar rates of in-hospital mortality (4.4% vs 6.1%, P = 0.42), in-hospital composite complications (66.7% vs 67.7%, P = 0.80), hospital length of stay (median 9 days; interquartile range [7-16] vs 10 [7-17], P = 0.41), and discharge disposition other than home (9.7% vs 11.7%, P = 0.55). Compared with patients who resided < 1 hour from the tertiary centre, patients who resided ≥ 1 hour were at higher risk for long-term mortality (hazard ratio, 2.19; 95% confidence interval, 1.13-4.28; P = 0.02).

      Conclusions

      Patients who reside remotely from the tertiary centre experience equivalent in-hospital outcomes but decreased long-term survival following ascending aortic operations. These findings may guide resource expansion for postoperative follow-up.

      Résumé

      Contexte

      L'association entre le temps du trajet au centre de soins tertiaires et le pronostic après une chirurgie de l'aorte thoracique ascendante est inconnue. Nous avons déterminé l'effet du temps de trajet au centre de soins tertiaires sur le pronostic de la réparation de l'aorte ascendante en Nouvelle-Écosse.

      Méthodes

      Une analyse rétrospective des patients subissant des chirurgies électives et émergentes de l'aorte thoracique ascendante entre 2005 et 2015 a été réalisée. Les coordonnées géographiques résidentielles des patients ont été utilisées pour calculer le temps de trajet vers le centre de soins tertiaires, et les patients qui résidaient < 1 heure vs ≥ 1 heure ont été comparés. Une régression logistique multivariée a été réalisée pour déterminer l'effet du temps de trajet sur les bilans hospitaliers. Un modèle de risque proportionnel de Cox et des estimations de survie de Kaplan-Meier ont été créés pour déterminer l'effet sur la survie à long terme.

      Résultats

      Un total de 476 patients ont subi une chirurgie de l'aorte thoracique ascendante entre 2005 et 2015. Les patients qui résidaient à moins d'une heure du centre de soins tertiaires par rapport aux patients qui résidaient à plus d'une heure présentaient des taux similaires de mortalité à l'hôpital (4,4 % contre 6,1 %, P = 0,42), de complications variées à l'hôpital (66,7 % contre 67,7 %, P = 0,80), de durée de séjour à l'hôpital (médiane de 9 jours; intervalle interquartile [7-16] contre 10 [7-17], P = 0,41) et d'un congé autre que pour le domicile (9,7 % contre 11,7 %, P = 0,55). Par rapport aux patients qui résidaient à moins d'une heure du centre tertiaire, les patients qui résidaient à plus d'une heure présentaient un risque plus élevé de mortalité à long terme (rapport de risque, 2,19; intervalle de confiance à 95 %, 1,13-4,28; P = 0,02).

      Conclusions

      Les patients qui résident à distance d'un centre tertiaire ont des résultats hospitaliers équivalents, mais ils ont une survie à long terme réduite après une chirurgie de l'aorte ascendante. Ces résultats peuvent guider le développement des ressources pour le suivi postopératoire.
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      Linked Article

      • Access to Thoracic Aortic Care: Challenges and Opportunities in Universal Health Coverage Systems
        Canadian Journal of CardiologyVol. 38Issue 6
        • Preview
          Access to cardiovascular care requires geographical accessibility, infrastructural capacity, health care quality, financial affordability, and societal acceptability.1 In high-income countries with universal health coverage (UHC) models, such as Canada, geographic accessibility remains 1 of the most pressing barriers.2,3 Canada is the second-largest country by total area and fourth by land mass but 236th in terms of population density.4 The inherent regionalization of cardiac surgery in Canada results in cardiac surgical centres concentrating in larger cities, whereas those living outside large cities are scattered across vast distances.
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