TY - JOUR
T1 - Impact of rural versus urban geographic location on length of stay after carotid endarterectomy
AU - Minc, Samantha D.
AU - Misra, Ranjita
AU - Holmes, Sari D.
AU - Ren, Yue
AU - Marone, Luke
N1 - Funding Information:
The authors would like to acknowledge Gary Hart, PhD, director of the Center for Rural Health for his guidance in the use of RUCA codes and the zip code crosswalk. The authors would also like to acknowledge Dan Neal, MS, director of analytics at the Society for Vascular Surgery Patient Safety Organization for his assistance with applying the zip code crosswalk to the VQI database prior to releasing the data.
Publisher Copyright:
© The Author(s) 2019.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - 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 < 0.001). Other factors that significantly increased risk for ELOS were non-White race/Latinx/Hispanic ethnicity (OR = 1.44, p < 0.001) and nonelective status (OR = 3.31, p < 0.001). In addition, patients treated at centers with a greater percentage of urban patients had greater risk for ELOS (OR = 1.008, p < 0.001). 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.
AB - 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 < 0.001). Other factors that significantly increased risk for ELOS were non-White race/Latinx/Hispanic ethnicity (OR = 1.44, p < 0.001) and nonelective status (OR = 3.31, p < 0.001). In addition, patients treated at centers with a greater percentage of urban patients had greater risk for ELOS (OR = 1.008, p < 0.001). 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.
KW - Carotid endarterectomy
KW - length of stay
KW - rural
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U2 - 10.1177/1708538119835402
DO - 10.1177/1708538119835402
M3 - Article
C2 - 30845899
AN - SCOPUS:85062725089
SN - 1708-5381
VL - 27
SP - 390
EP - 396
JO - Vascular
JF - Vascular
IS - 4
ER -