How Far Are Patients Willing to Travel for Gastrectomy?

Abstract

Objective: To determine travel patterns for patients undergoing gastrectomy for cancer, and to identify factors associated with patient decision. Summary Background Data: Support for regionalization of complex surgery grows, yet little is known about the willingness of patients to travel for care. Furthermore, utilization of quality data in patients’ hospital selection processes is not well understood. Methods: Analysis of the California Office of Statewide Health Planning and Development database from 1996 to 2009. Outcome measures included total distance traveled and rate of bypassing the nearest gastrectomy-performing hospitals. Multivariate analyses to identify predictors of bypassing local hospitals were performed. Results: Total study population was 10,022. Majority (67.1%) of patients underwent gastrectomy at the nearest providing hospitals. Distance traveled to destination hospitals in California averaged 17.04 miles. Bypassing patients traveled approximately 16 miles beyond the nearest hospitals to receive care, selecting lower volume destination hospitals in 27.9% of cases. Annual gastrectomy volumes for nearest and for destination hospitals averaged 4.4 and 6.8 cases, respectively, and in-hospital mortality rates were 5.9% and 4.8%, respectively. Few patients (19.2%) sought care at teaching hospitals. Rural county residence significantly reduced the likelihood of bypass (p<0.001). High volume (>7 cases) and teaching status of destination hospitals (both p<0.001) were predictive of hospital bypass, though no significant association between mortality rate and bypass was identified. Conclusions: The majority of gastric cancer patients underwent gastrectomy at providing hospitals nearest to home, reflecting little regionalization of gastrectomy in California. Patients’ hospital selection appears not to be driven by outcomes data.