Impact of travel distance on short-term outcomes in patients receiving treatment for urolithiasis: A population-based study.

Abstract

We aimed to assess the relationship between the distance traveled to receive treatment for urolithiasis and early outcomes. This is a population-based study of patients who received interventions for urolithiasis in Ontario between 2003 and 2019 using administrative data. Patients were stratified into three groups according to the distance travelled. Descriptive statistics and the Chi-squared test were used to examine differences between these groups based on the urolithiasis treatment of choice. The primary outcomes were reoperation rates and readmission rates. To identify the factors associated with the co-primary outcomes, both univariate and multivariable logistic regression models were employed. A total of 127 195 patients were included in the final analysis, with the majority of patients (n=100 124, 78.7%) having their stone procedure within 30 km from their residence, whereas 9586 patients (7.5%) travelled a distance greater than 90 km. Most of those that travelled >90 km were for extracorporeal shock wave lithotripsy (ESWL) (59%). Type of procedure and region of residence were the only variables that appeared to have a clinically relevant association with greater distance travelled. Unadjusted analysis suggested longer distance travelled was associated with a decrease in the need for a repeat procedure; however, this was likely confounded by an association between distance traveled and procedure type. In adjusted analysis, early post-procedure health resource use did not appear to be dramatically increased with greater distance from care. Indeed, readmission rates at 30 days were marginally lower among those who travelled 30-60 km vs. <30 km (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.80-0.92, and had no detectable difference at >90 km vs. <30 km (OR 0.97, 95% CI 0.88, 1.08). These observations of fewer or no difference in readmissions and emergency visits for those that travelled the greatest distances generally held true in the subgroup analysis for each surgical procedure. This population-based study found no clinically remarkable associations between the distance travelled for urolithiasis treatment and early outcomes. In fact, some marginal decreases in resource use were observed with greater travel distance perhaps reflecting some effect of travel to higher volume referral centers or enhanced processes for those that needed to travel farther for care. This information could be important for clinicians to help appropriate counselling and health systems planning.