Geographic access to care and pediatric surgical outcomes

Introduction: Rurality and distance traveled for healthcare are associated with worse pediatric health indicators. Methods: We retrospectively analyzed patients ages 0-21 at a quaternary pediatric surgical facility with a large rural catchment area between 1/1/2016-12/31/2020. Patient addresses were designated as metropolitan or non-metropolitan. 60-and 120-min driving rings from our institution were calculated. Logistic regression assessed the effect of rurality and distance traveled for care on postoperative mortality and serious adverse events (SAE). Results: Among 56,655 patients, 84.3% were from metropolitan areas, 8.4% from non-metropolitan areas, and 7.3% could not be geocoded. 64% were within 60-min driving and 80% within 120-min. On univariable regression, patients living >120-min experienced 59% (95% CI: 1.09, 2.30) increased odds of mortality and 97% (95% CI: 1.84, 2.12) increased odds of SAE compared to those <60-min. Non-metropolitan patients experienced 38% (95% CI: 1.26, 1.52) increased odds of a serious postoperative event compared to metropolitan patients. Discussion: Efforts to improve geographic access to pediatric care are needed to mitigate the impact of rurality and travel time on inequitable surgical outcomes.

Automated summary

This study retrospectively analyzed pediatric patients aged 0-21 at a large rural catchment area surgical facility. The results showed that patients living more than 120 minutes away from the facility had an increased risk of postoperative mortality and serious adverse events, while non-metropolitan patients had an increased risk of serious postoperative events.