Taking the Long Way to Care: Who is Traveling Farthest to Undergo Elective Total Hip Arthroplasty?

Abstract

Background: Disparities in access to total hip arthroplasty (THA) exist. The purpose of this study is to examine how distance traveled to undergo elective THA correlates with sociodemographic variables and postoperative outcomes. Material and methods: The Healthcare Cost and Utilization Project New York and Florida state inpatient databases were used to identify patients who underwent elective THA between 2006 and 2014. Data from the American Hospital Association and United States Postal Service were used to calculate the distance patients traveled to receive THA, and only those who traveled more than 25 miles were included. We stratified patients into 4 groups based on their distance traveled (25-50 miles, 50.01-100 miles, 100.01-500 miles, and >500.01 miles) and compared demographic characteristics and postoperative outcomes between groups. Results: Age, race, insurance provider, zip code income quartile, and Charlson Comorbidity Index scores were each significantly associated with travel distance (P < .001) among our cohort of 25,734 patients. Patients who were older, were white, had Medicare insurance coverage, lived in zip codes with a higher median household income, and had increased comorbidities were more likely to travel the farthest to receive care. There were minimal associations between travel distance and postoperative outcomes. Conclusion: There may be specific demographic groups who either are forced to travel long distances to receive care or have the resources to seek out and travel to distant hospitals in an effort to receive optimal care. Understanding the interconnected relationships between demographic variables is necessary to address disparities in access to specialized orthopedic surgical care.

Keywords

• Hip arthroplasty
• Disparities
• Travel distance
• Access to care