Increased Distance From the Tertiary Cardiac Center Is Associated With Worse 30-Day Outcomes After Cardiac Operations.
BACKGROUND
Numerous studies have examined the effect of geographic place of residence on access to cardiovascular care, but few have examined their effect on outcomes after cardiac operations. This study examined the effect of geographic place of residence on in-hospital and 30-day outcomes after cardiac operations.


METHODS
We performed a retrospective analysis of all patients undergoing nonemergency cardiac operations at a single institution between April 2004 and March 2011. Geographic place of residence was defined as the driving distance from the patient's home to the tertiary cardiac care center divided into the following categories: 0 to 50 km, 50 to 100 km, 100 to 150 km, 150 to 200 km, 200 to 250 km, and more than 250 km. Multivariable logistic regression was used to determine the independent effect of driving distance on in-hospital and 30-day outcomes.


RESULTS
The final study population included 4,493 patients, of whom 3,897 (86.7%) had 30-day follow-up. After adjusting for differences among patient groups, no consistent relationship existed between distance and in-hospital outcomes. However, increased distance beyond 100 km was significantly associated with a greater risk of adverse outcomes at 30 days (0 to 50 km: referent; 50 to 100 km: odds ratio, 1.16 [95% confidence interval, 0.83 to 1.62]; 100 to 150 km: 1.32 [1.05 to 1.65], 150 to 200 km: 1.68 [1.33 to 2.11], 200 to 250 km: 1.41 [1.06 to 1.88], and >250 km: 1.30 [1.04 to 1.63]).


CONCLUSIONS
Patients who live at an increased distance from the tertiary cardiac care center are more likely to have worse 30-day outcomes after cardiac operations. Further study is required to determine the mechanisms underlying this relationship and how such inequalities may be minimized.
Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.
Claudia L
CL
Cote
Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.
Shubhi
S
Singh
Cardiovascular Research New Brunswick, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
Alexandra M
AM
Yip
Horizon Health Network, Saint John, New Brunswick, Canada.
Joshua
J
Murray
Cardiovascular Research New Brunswick, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
Jeffrey B
JB
MacLeod
Cardiovascular Research New Brunswick, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
Sohrab
S
Lutchmedial
Cardiovascular Research New Brunswick, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
Craig D
CD
Brown
Cardiovascular Research New Brunswick, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
Rand
R
Forgie
Cardiovascular Research New Brunswick, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
Marc P
MP
Pelletier
Cardiovascular Research New Brunswick, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, New Brunswick, Canada. Electronic address: ahassan@dal.ca.
Ansar
A
Hassan
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009509:New Brunswick / Q000453:epidemiology; D016017:Odds Ratio; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors