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01-01-2019 | Clinical Study

The impact of traveling distance and hospital volume on post-surgical outcomes for patients with glioblastoma

Authors: Christian Lopez Ramos, Michael G. Brandel, Jeffrey A. Steinberg, Arvin R. Wali, Robert C. Rennert, David R. Santiago-Dieppa, Reith R. Sarkar, J. Scott Pannell, James D. Murphy, Alexander A. Khalessi

Published in: Journal of Neuro-Oncology | Issue 1/2019

Abstract

Background

High-volume hospitals are associated with improved outcomes in glioblastoma (GBM). However, the impact of travel burden to high-volume centers is poorly understood. We examined post-operative outcomes between GBM patients that underwent treatment at local, low-volume hospitals with those that traveled long distances to high-volume hospitals.

Methods

The National Cancer Database was queried for GBM patients that underwent surgery (2010–2014). We established two cohorts: patients in the lowest quartile of travel distance and volume (Short-travel/Low-Volume: STLV) and patients in the highest quartile of travel and volume (Long-travel/High-Volume: LTHV). Outcomes analyzed were 30-day, 90-day mortality, overall survival, 30-day readmission, and hospital length of stay.

Results

Of 35,529 cases, STLV patients (n = 3414) traveled a median of 3 miles (Interquartile range [IQR] 1.8–4.2) to low-volume centers (5 [3–7] annual cases) and LTHV patients (n = 3808) traveled a median of 62 miles [44.1–111.3] to high-volume centers (48 [42–71]). LTHV patients were younger, had lower Charlson scores, largely received care at academic centers (84.4% vs 11.9%), were less likely to be minorities (8.1% vs 17.1%) or underinsured (6.9% vs 12.1), and were more likely to receive trimodality therapy (75.6% vs 69.2%; all p < 0.001). On adjusted analysis, LTHV predicted improved overall survival (HR 0.87, p = 0.002), decreased 90-day mortality (OR 0.72, p = 0.019), lower 30-day readmission (OR 0.42, p < 0.001), and shorter hospitalizations (RR 0.79, p < 0.001).

Conclusions

Glioblastoma patients who travel farther to high-volume centers have superior post-operative outcomes compared to patients who receive treatment locally at low-volume centers. Strategies that facilitate patient travel to high-volume hospitals may improve outcomes.

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Title: The impact of traveling distance and hospital volume on post-surgical outcomes for patients with glioblastoma
Authors: Christian Lopez Ramos
Michael G. Brandel
Jeffrey A. Steinberg
Arvin R. Wali
Robert C. Rennert
David R. Santiago-Dieppa
Reith R. Sarkar
J. Scott Pannell
James D. Murphy
Alexander A. Khalessi
Publication date: 01-01-2019
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 1/2019
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-018-03022-w

At a glance: The STEP trials

Springer Medicine

The impact of traveling distance and hospital volume on post-surgical outcomes for patients with glioblastoma

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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