PDF(Pubmed)
Abstract：
OBJECTIVE: To investigate the association between travel distance and postoperative length of stay (LOS) and discharge disposition among veterans undergoing surgical aortic valve replacement (SAVR).
METHODS: We performed a retrospective cohort study of patients undergoing SAVR, with or without coronary artery bypass grafting (CABG) at VA Boston Healthcare (January 1, 2005-December 31, 2015).
METHODS: Postoperative LOS and discharge disposition were compared for SAVR patients based on travel distance to the facility: <100 miles or ≥100 miles. Multivariable regression was performed to ascertain factors associated with LOS and home discharge.
METHODS: Data were collected via chart review. All patients undergoing SAVR at our institution who primarily resided within the defined region were included.
RESULTS: Of 597 patients studied, 327 patients underwent isolated SAVR; 270 patients underwent SAVR/CABG. Overall median (IQR) distance between the patient\'s residence and the hospital was 49.95 miles (27.41-129.94 miles); 190 patients (32%) resided further than 100 miles away. There were no differences in the proportion of patients with diabetes, hypertension, chronic obstructive pulmonary disease (COPD), cerebrovascular disease, atrial fibrillation, or prior myocardial infarction between groups. Overall LOS (IQR) was 9 (7-13) days and did not differ between groups (p = 0.18). The proportion of patients discharged home was higher among patients who resided more than 100 miles from the hospital (71% vs. 58%, p = 0.01). On multivariable analysis, residing further than 100 miles from the hospital was independently associated with home discharge (OR = 1.64, 95% CI: 1.09-2.48). Travel distance was not associated with LOS.
CONCLUSIONS: Based on our institutional experience, potential concerns of longer hospital stay or discharge to other inpatient facilities for geographically distanced patients undergoing SAVR do not appear supported. Continued examination of the drivers underlying the marked shift of veterans to the private sector appears warranted.
METHODS: We performed a retrospective cohort study of patients undergoing SAVR, with or without coronary artery bypass grafting (CABG) at VA Boston Healthcare (January 1, 2005-December 31, 2015).
METHODS: Postoperative LOS and discharge disposition were compared for SAVR patients based on travel distance to the facility: <100 miles or ≥100 miles. Multivariable regression was performed to ascertain factors associated with LOS and home discharge.
METHODS: Data were collected via chart review. All patients undergoing SAVR at our institution who primarily resided within the defined region were included.
RESULTS: Of 597 patients studied, 327 patients underwent isolated SAVR; 270 patients underwent SAVR/CABG. Overall median (IQR) distance between the patient\'s residence and the hospital was 49.95 miles (27.41-129.94 miles); 190 patients (32%) resided further than 100 miles away. There were no differences in the proportion of patients with diabetes, hypertension, chronic obstructive pulmonary disease (COPD), cerebrovascular disease, atrial fibrillation, or prior myocardial infarction between groups. Overall LOS (IQR) was 9 (7-13) days and did not differ between groups (p = 0.18). The proportion of patients discharged home was higher among patients who resided more than 100 miles from the hospital (71% vs. 58%, p = 0.01). On multivariable analysis, residing further than 100 miles from the hospital was independently associated with home discharge (OR = 1.64, 95% CI: 1.09-2.48). Travel distance was not associated with LOS.
CONCLUSIONS: Based on our institutional experience, potential concerns of longer hospital stay or discharge to other inpatient facilities for geographically distanced patients undergoing SAVR do not appear supported. Continued examination of the drivers underlying the marked shift of veterans to the private sector appears warranted.
摘要：
目的：探讨接受外科主动脉瓣置换术（SAVR）的退伍军人的旅行距离与术后住院时间（LOS）和出院处置之间的关系。
方法：我们对接受SAVR的患者进行了一项回顾性队列研究，在VABostonHealthcare进行或不进行冠状动脉旁路移植术（CABG）（2005年1月1日至2015年12月31日）。
方法：根据到设施的行程距离：<100英里或≥100英里，比较了SAVR患者的术后LOS和出院处置。进行多变量回归以确定与LOS和家庭出院相关的因素。
方法：通过图表审查收集数据。包括在我们机构接受SAVR的所有患者，这些患者主要居住在定义的区域内。
结果：在研究的597名患者中，327例患者接受了单独的SAVR；270例患者接受了SAVR/CABG。患者住所与医院之间的总距离中位数（IQR）为49.95英里（27.41-129.94英里）；190名患者（32％）居住在100英里以外。糖尿病患者的比例没有差异，高血压,慢性阻塞性肺疾病(COPD),脑血管疾病，心房颤动,或组间先前的心肌梗塞。总体LOS（IQR）为9（7-13）天，组间无差异（p=0.18）。在距医院100英里以上的患者中，出院的患者比例较高(71%vs.58%,p=0.01)。在多变量分析中，居住在距医院100英里以上与家庭出院独立相关(OR=1.64,95%CI:1.09-2.48).旅行距离与LOS无关。
结论：根据我们的机构经验，对于地理位置较远的接受SAVR的患者，可能存在的住院时间更长或出院到其他住院设施的问题似乎没有得到支持。似乎有必要继续审查退伍军人向私营部门转移的潜在驱动因素。
方法：我们对接受SAVR的患者进行了一项回顾性队列研究，在VABostonHealthcare进行或不进行冠状动脉旁路移植术（CABG）（2005年1月1日至2015年12月31日）。
方法：根据到设施的行程距离：<100英里或≥100英里，比较了SAVR患者的术后LOS和出院处置。进行多变量回归以确定与LOS和家庭出院相关的因素。
方法：通过图表审查收集数据。包括在我们机构接受SAVR的所有患者，这些患者主要居住在定义的区域内。
结果：在研究的597名患者中，327例患者接受了单独的SAVR；270例患者接受了SAVR/CABG。患者住所与医院之间的总距离中位数（IQR）为49.95英里（27.41-129.94英里）；190名患者（32％）居住在100英里以外。糖尿病患者的比例没有差异，高血压,慢性阻塞性肺疾病(COPD),脑血管疾病，心房颤动,或组间先前的心肌梗塞。总体LOS（IQR）为9（7-13）天，组间无差异（p=0.18）。在距医院100英里以上的患者中，出院的患者比例较高(71%vs.58%,p=0.01)。在多变量分析中，居住在距医院100英里以上与家庭出院独立相关(OR=1.64,95%CI:1.09-2.48).旅行距离与LOS无关。
结论：根据我们的机构经验，对于地理位置较远的接受SAVR的患者，可能存在的住院时间更长或出院到其他住院设施的问题似乎没有得到支持。似乎有必要继续审查退伍军人向私营部门转移的潜在驱动因素。
