How far We Go For Surgery: Distance to Pediatric Surgical Care in Indiana

Cassandra Anderson; Ben Duggan; Cameron Colgate; Manisha Bhatia; Brian Gray

doi:10.1016/j.jpedsurg.2024.03.008

How far We Go For Surgery: Distance to Pediatric Surgical Care in Indiana

J Pediatr Surg. 2024 Mar 15:S0022-3468(24)00159-3. doi: 10.1016/j.jpedsurg.2024.03.008. Online ahead of print.

Authors

Cassandra Anderson¹, Ben Duggan², Cameron Colgate³, Manisha Bhatia⁴, Brian Gray⁴

Affiliations

¹ Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA; Section of Pediatric Surgery, Riley Hospital for Children, 705 Riley Hospital Drive RI2500, Indianapolis, IN, 46202, USA. Electronic address: cassie.m.anderson24@gmail.com.
² Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA.
³ Center for Outcomes Research in Surgery, Indiana University School of Medicine, 410 W 10th Street, HITS, Suite 2000, Indianapolis, IN, 46202, USA.
⁴ Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA; Section of Pediatric Surgery, Riley Hospital for Children, 705 Riley Hospital Drive RI2500, Indianapolis, IN, 46202, USA.

PMID: 38582703
DOI: 10.1016/j.jpedsurg.2024.03.008

Abstract

Introduction: Despite increasing numbers of pediatric surgery training programs, access to pediatric surgical care remains limited in non-academic and rural settings. We aimed to characterize demographic and patient factors associated with increased distance to selected pediatric surgical procedures in Indiana.

Methods: This IRB-approved retrospective review analyzed pediatric patients undergoing appendectomy, cholecystectomy, umbilical hernia repair, pyloromyotomy, and video assisted thoracic surgery (VATS) procedures from 2019 through 2021. Data was obtained from an electronic medical record warehouse and the Indiana Hospital Association. Travel distance was calculated as driving distance between patient address and hospital ZIP codes. Statistics were performed in R, with p < 0.05 indicating significance.

Results: There were 6835 operations performed, and half of all operations (46%) were performed at institutions with fellowship-trained pediatric surgeons. The median travel distance for all operations was 13 miles (range 0-182); the shortest was for laparoscopic appendectomy (9 miles, IQR[0-20]). The longest distances were for pyloromyotomy (51 miles, IQR[14-84]) and VATS procedures (57 miles, IQR[13-111]), of which, nearly all were performed at tertiary pediatric care centers (97% and 93%, respectively). There was a significant linear and quadratic effect of age on travel distance (p < 0.001), with younger patients requiring farther travel. On multivariable linear regression, age and procedure type had the largest effect on travel distance (Eta squared 0.03, p < 0.001).

Conclusion: Younger age and more specialized procedures, including VATS and pyloromyotomy, were associated with increased travel distance. This highlights regionalization of these procedures to urban areas with pediatric care centers, while others are performed closer to home.

Level of evidence: III TYPE OF STUDY: Retrospective comparative study.

Keywords: Appendectomy; Distance; Geographic access to care; Neonatal surgery; Pediatric surgery; Rural surgery; Travel; VATS.