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Longer travel times for emergency surgical care increase case presentation complexity and healthcare system resource utilization, according to a recent study.

Longer patient travel times for emergency surgical care correlate with more complex presentations and increased operative interventions, transfers, admissions, extended stays, and costs, according to a study published online in JAMA Network Open.

According to the authors, timely access to emergency care is a critical performance metric for health systems, particularly for conditions in which delays exacerbate morbidity and mortality, such as surgical emergencies. Yet the relationship between travel time to an emergency facility and disease severity at presentation remained inadequately characterized.

“Importantly, we evaluated travel time from patients’ homes to the facilities where they received emergency care—regardless of whether those facilities were able to provide definitive surgical care,” wrote corresponding author John W. Scott, MD, MPH, of the University of Washington, and study coauthors. “Therefore, we highlighted the potential benefit of preserving timely access to emergency departments that can provide initial care and stabilization of surgical patients, even if these facilities lack definitive surgical capabilities.”

Retrospective Analysis

To examine whether prolonged travel time correlates with more complex disease on arrival, downstream clinical outcomes, and health system resource use, the researchers conducted a retrospective cohort analysis using statewide inpatient and emergency department administrative databases from Florida and California, encompassing nearly all adult encounters in 2021. The study included patients presenting with one of five common emergency general surgery conditions—appendicitis, cholecystitis, diverticulitis, hernia, or bowel obstruction. Travel time from the patient’s residence to the initial treating facility was the primary exposure, categorized as 15 minutes or less, 16–60 minutes, 61–120 minutes, and more than 120 minutes. The principal outcome was surgical disease complexity at presentation, defined by standardized severity criteria. Secondary outcomes comprised inpatient complications, in-hospital mortality, operative intervention, length of stay, interfacility transfer, and total hospital charges. Multivariable logistic and linear regression models adjusted for demographics, comorbidities, insurance status, and hospital characteristics, reporting adjusted odds ratio (aOR) or mean differences with 95% confidence intervals (CI).

Impact of Travel Time

Of 190,311 adults with emergency surgical conditions, 7,138 (3.8%) resided more than 60 minutes from their treating facility. Compared to those within 15 minutes, patients traveling over 120 minutes exhibited significantly higher odds of presenting with complex disease (aOR 1.28; 95% CI 1.17–1.40). Extended travel time (≥ 60 minutes) was also independently associated with increased likelihood of operative intervention (aOR 1.17; 95% CI 1.10–1.26), inpatient admission (aOR 1.41; 95% CI 1.33–1.50), and interfacility transfer (aOR 1.32; 95% CI 1.15–1.51). Furthermore, these patients experienced a longer adjusted inpatient stay by 0.47 days (95% CI 0.35–0.59) and incurred higher hospital charges by $8,284 (95% CI 5,532–11,035).

“Prolonged travel time was not only associated with poor patient-level access to care, but with increased health system resource utilization as well,” the researchers wrote. “Patients with longer travel times were more likely to require an operation, be admitted as inpatients, undergo interfacility transfer, have longer lengths of stay, and incur higher charges.”

Travel Time as a Guide to Policy Decisions

The study authors suggested that travel time, as a dynamic indicator of access, may prove more actionable than static designations such as rurality when guiding policy decisions, adding, “These findings suggest that policymakers should account for proximity to emergency care when considering impacts of rural hospital closures and policy efforts to preserve timely access to care.”