The effect of geographic origin and destination on congenital heart disease outcomes: a retrospective cohort study

BMC Cardiovascular Disorders

Research

Cara H. Olsen¹  Ryan P. Flanagan²  John S. Scott³  Craig P. Dobson⁴  Spencer M. Millen⁴ 

[1] Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA;Tripler Army Medical Center, Honolulu, HI, USA;Veterans’ Health Administration, Washington, DC, USA;Walter Reed National Military Medical Center, Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA;

关键词: Congenital heart disease (CHD);    Distance;    Rurality;    Rural;    Urban;    Society of thoracic surgery (STS);   

DOI  :  10.1186/s12872-023-03037-w

 received in 2022-06-19, accepted in 2023-01-02,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundCongenital heart disease (CHD) is a common and significant birth defect, frequently requiring surgical intervention. For beneficiaries of the Department of Defense, a new diagnosis of CHD may occur while living at rural duty stations. Choice of tertiary care center becomes a function of geography, referring provider recommendations, and patient preference.MethodsUsing billing data from the Military Health System over a 5-year period, outcomes for beneficiaries age < 10 years undergoing CHD surgery were compared by patient origin (rural versus urban residence) and the distance to treatment (patient’s home and the treating tertiary care center). These beneficiaries include children of active duty, activated reserves, and federally activated National Guard service members. Analysis of the outcomes were adjusted for procedure complexity risk. Treatment centers were further stratified by annual case volume and whether they publicly reported results in the society of thoracic surgery (STS) outcomes database.ResultsWhile increasing distance was associated with the cost of admission, there was no associated risk of inpatient mortality, one year mortality, or increased length of stay. Likewise, rural origination was not significantly associated with target outcomes. Patients traveled farther for STS-reporting centers (STS-pr), particularly high-volume centers. Such high-volume centers (> 50 high complexity cases annually) demonstrated decreased one year mortality, but increased cost and length of stay.ConclusionsTogether, these findings contribute to the national conversation of rural community medicine versus regionalized subspecialty care; separation of patients between rural areas and more urban locations for initial CHD surgical care does not increase their mortality risk. In fact, traveling to high volume centers may have an associated mortality benefit.

【 授权许可】

CC BY   
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023

【 图 表 】

Fig. 3