Increased Travel Time to the Tertiary Centre Is Associated With Decreased Long-term Survival Following Ascending Aortic Operations.

Abstract

The association between travel time from tertiary care centre and outcomes after ascending thoracic aortic surgery is unknown. We determined the effect of travel time from the tertiary care centre on outcomes in ascending aortic repair in Nova Scotia. A retrospective analysis of patients undergoing elective and emergent ascending thoracic aortic operations from 2005 to 2015 was carried out. Patient's residential geographic coordinates were used to calculate travel time to the tertiary care centre, and patients who resided < 1 hour vs ≥ 1 hour were compared. Multivariable logistic regression was performed to determine the effect of travel time on in-hospital outcomes. Cox-proportional hazard modelling and Kaplan-Meier survival estimates were created to determine the effect on long-term survival. A total of 476 patients underwent ascending thoracic aortic surgery from 2005 to 2015. Patients who resided < 1 hour from the tertiary care centre vs patients who resided ≥ 1 hour had similar rates of in-hospital mortality (4.4% vs 6.1%, P= 0.42), in-hospital composite complications (66.7% vs 67.7%, P= 0.80), hospital length of stay (median 9 days; interquartile range [7-16] vs 10 [7-17], P= 0.41), and discharge disposition other than home (9.7% vs 11.7%, P= 0.55). Compared with patients who resided < 1 hour from the tertiary centre, patients who resided ≥ 1 hour were at higher risk for long-term mortality (hazard ratio, 2.19; 95% confidence interval, 1.13-4.28; P= 0.02). Patients who reside remotely from the tertiary centre experience equivalent in-hospital outcomes but decreased long-term survival following ascending aortic operations. These findings may guide resource expansion for postoperative follow-up.