Impact of rural versus urban geographic location on length of stay after carotid endarterectomy

Autor: Yue Ren, Sari D. Holmes, Luke Marone, Samantha D. Minc, Ranjita Misra
Rok vydání: 2019
Předmět:
Carotid Artery Diseases
Male
medicine.medical_specialty
Time Factors
Quality management
Databases
Factual
media_common.quotation_subject
medicine.medical_treatment
Carotid endarterectomy
030204 cardiovascular system & hematology
Risk Assessment
Article
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Risk Factors
Urban Health Services
Humans
Medicine
Radiology
Nuclear Medicine and imaging
Quality (business)
030212 general & internal medicine
Location
Aged
Quality Indicators
Health Care
Retrospective Studies
media_common
Endarterectomy
Carotid
business.industry
Incidence (epidemiology)
General Medicine
Length of Stay
Middle Aged
United States
Treatment Outcome
Emergency medicine
Female
Surgery
Rural Health Services
Cardiology and Cardiovascular Medicine
business
Zdroj: Vascular
ISSN: 1708-539X
1708-5381
DOI: 10.1177/1708538119835402
Popis: Background Reducing the incidence of extended length of stay (ELOS) after carotid endarterectomy (CEA), defined as LOS > 1 day, is an important quality improvement focus of the Vascular Quality Initiative (VQI). Rural patients with geographic barriers pose a particular challenge for discharge and may have higher incidences of ELOS as a result. The purpose of this study was to examine the impact of patients’ home geographic location on ELOS after CEA. Methods The VQI national database for CEA comprised the sample for analyses ( N = 66,900). Rural-Urban Commuting Area (RUCA) codes, a validated system used to classify the nation’s census tracts according to rural and urban status, was applied to the VQI database and used to indicate patients’ home geographic location. LOS was categorized into two groups: LOS ≤ 1 day (66%) and LOS > 1 day (ELOS) (34%). Multivariable logistic regression was conducted to examine the effect of geographic location on ELOS after adjustment for age, gender, race, and comorbid conditions. Results A total of 66,900 patients were analyzed and the mean age of the sample was 70.5 ± 9.3 years (40% female). After adjustment for covariates, the urban group had increased risk for ELOS (OR = 1.20, p Conclusions These analyses found that geographic location did impact LOS, but not in the hypothesized direction. Even with adjustment for comorbidities and other factors, patients from urban areas and centers with more urban patients were more likely to have ELOS after CEA. These findings suggest that other mechanisms, such as racial disparities, barriers in access to care, and disparities in support after discharge for urban patients may have a significant impact on LOS.
Databáze: OpenAIRE
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