title: Distance to hospital and utilization of surgical services in Haiti: do children, delivering mothers, and patients with emergent surgical conditions experience greater geographical barriers to surgical care?
abstract: BACKGROUND
  An inverse relationship between healthcare utilization and distance to care has been previously described. The purpose of this study was to evaluate this effect related to emergency and essential surgical care in central Haiti.
  
  
  METHODS
  We conducted a retrospective review of operative logbooks from the Clinique Bon Sauveur in Cange, Haiti, from 2008 to 2010. We used Geographic Information Systems to map the home locations of all patients. Spearman's correlation was used to determine the relationship between surgical utilization and distance, and a multivariate linear regression model identified characteristics associated with differences in distances traveled to care.
  
  
  RESULTS
  The highest annual surgical utilization rate was 184 operations/100,000 inhabitants. We found a significant inverse correlation between surgical utilization rate and distance from residence to hospital (rs = -0.68, p = 0.02). The median distance from residence to hospital was 55.9 km. Pediatric patients lived 10.1% closer to the hospital than adults (p < 0.01), and distance from residence to hospital was not significantly different between men and women (p = 0.25). Patients who received obstetric or gynecologic surgery originated 7.8% closer to the hospital than patients seeking other operations (p < 0.01), and patients who received emergent surgical care originated 24.8% closer to the hospital than patients who received elective surgery (p < 0.01).
  
  
  CONCLUSIONS
  Utilization of surgical services was low and inversely related to distance from residence to hospital in rural areas of central Haiti. Children and patients receiving obstetric, gynecologic or emergent surgery lived significantly closer to the hospital, and these groups may need special attention to ensure adequate access to surgical care.
authors.affiliation: Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Friedman
authors.forename: Lars
authors.initials: L
authors.lastname: Hagander
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Hughes
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Nash
authors.forename: Allison F
authors.initials: AF
authors.lastname: Linden
authors.forename: Jeff
authors.initials: J
authors.lastname: Blossom
authors.forename: John G
authors.initials: JG
authors.lastname: Meara
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D040362:Geographic Information Systems; D006205:Haiti; D006297:Health Services Accessibility; D006801:Humans; D016014:Linear Models; D008297:Male; D011247:Pregnancy; D011996:Records; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*