342 - Does it matter where you live? An exploration into the association between geographic proximity to care and pediatric surgical outcomes in British Columbia

Poster Number: 342
Publication Number: 342.1755

Background: BC Children’s Hospital (BCCH) is the only pediatric tertiary care hospital for British Columbia (BC) and Yukon. One potential drawback of this highly centralized and specialized care model is the potential for variances in health outcomes for geographically remote patients. Recent literature has suggested remoteness of residence from surgical care might adversely influence pediatric surgical outcomes.

Objective: Our study aims to examine surgical outcomes related to remoteness of residence from BCCH to provide insights to potentially optimize current care, and guide Pediatric surgical care models in the future.

Design/Methods: Data was collected from all patients with surgical outcomes and home address data between 2017-2022 in the prospectively maintained and validated BCCH National Surgical Quality Improvement Program (NSQIP) database. We defined surgical outcomes by readmission within 30 days, surgical site infections, 30-day mortality, unplanned return surgical procedures, and a composite of adverse events.

Results: Data from 3849 surgical patients were evaluated for this study. There is no statistically significant association between driving time from BCCH ( < 2 hour drive, n=2772; ≥ 2 hours drive, n=1077) and negative outcomes (p=0.30). ASA classification, surgical specialty, case acuity, age, and duration of surgery were significant univariate predictors for adverse events. When adjusting for covariates in the logistic regression model, driving time remains statistically insignificant as a predictor of having a negative surgical outcome (p=0.41).

Conclusion(s): Given the size of the cohort, the high-quality database, and the predictive strength of typical factors involved in surgical outcomes, there is a degree of confidence that geographic proximity is not a strong predictor of outcomes of pediatric surgical care in our population. Our finding, which affirms a centralized and specialized pediatric surgical system, has important implications in determining care models for the geographically challenging Canadian healthcare system.