Distance to Treatment with Radical Cystectomy in a Rural State: Long Car Rides, Equivalent Outcomes.

Abstract

Radical Cystectomy (RC) is a complex surgery with better outcomes reported when performed at high volume centers. This may lead to patients traveling farther for care. We examined the impact of travel distance on clinical outcomes. 220 patients undergoing RC from 2015-2021 were retrospectively reviewed. Distance traveled to the treatment center by patient zip codes was classified as <12.5 mi, 12.5-49.9 mi, and ≥50 mi. Multivariable logistic regression was used to assess complications, readmissions, 90d mortality, and length of stay (LOS) by distance traveled. Time to treatment (TTT) based on distance traveled was compared. 220 pts underwent RC with complete 90d follow-up. 38.6% of pts (85/220) were readmitted. 62.5% (53/85) presented to the treatment center or were transferred. All pts readmitted to an outside hospital (OSH) traveled ≥12.5 mi (p<0.001). Patients with high-grade complications were likely to be transferred to the treatment center with only 23.7% (9/38) definitively managed by OSH. Pts traveling >12.5 mi with low-grade complications were more likely to be managed at an OSH (57.5%, p = 0.01). There was no difference in time to initiation of neoadjuvant chemotherapy (p=0.99) or time to RC following NAC (p=0.23) by distance traveled. For 49 MIBC patients proceeding directly to surgery without NAC, time from diagnosis to RC was increased if traveling >12.5 mi (p=0.04). Increased travel distance did not impact early postoperative outcomes. Distance traveled may impact access to care, such as time to surgery or location of readmission to the treatment center post-operatively.