Abstract
INTRODUCTION: We aimed to assess the relationship between the distance traveled to receive treatment for urolithiasis and early outcomes. METHODS: Using administrative data, patients who received interventions for urolithiasis in Ontario between 2003 and 2019 were stratified into three groups according to distance traveled. Descriptive statistics and the Chi-squared test were used to examine differences between these groups based on the treatment of choice. The primary outcomes were reoperation and readmission rates. To identify the factors associated with the co-primary outcomes, both univariate and multivariable logistic regression models were used. RESULTS: A total of 127 195 patients were included in the final analysis, with most patients (78.7%) having their stone procedure within 30 km from their residence, whereas 7.5% traveled a distance >90 km. Most of those who traveled >90 km were for extracorporeal shockwave lithotripsy (ESWL) (59%). Type of procedure and region of residence were the only variables that appeared to have a clinically relevant association with greater distance traveled. Unadjusted analysis suggested longer distance traveled was associated with a decrease in the need for a repeat procedure; however, this was likely confounded by an association between distance traveled and procedure type. In adjusted analysis, early post-procedure health resource use did not appear to be dramatically increased with greater distance from care; readmission rates at 30 days were marginally lower among those who traveled 30-60 km vs. <30 km (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.80-0.92) and had no detectable difference at >90 km vs. <30 km (OR 0.97, 95% CI 0.88-1.08). These observations of fewer or no difference in readmissions and emergency visits for those that traveled the greatest distances generally held true in the subgroup analysis for each surgical procedure. CONCLUSIONS: This population-based study found no clinically remarkable associations between the distance traveled for urolithiasis treatment and early outcomes. In fact, some marginal decreases in resource use were observed with greater travel distance, perhaps reflecting some effect of travel to higher-volume referral centers or enhanced processes for those that needed to travel farther for care.