PM3 - Travel Distance and the Impact on Post-Surgical Outcomes and Overall Survival after CRS/HIPEC. A Study from the US HIPEC Collaborative

Background There has been a gradual increase in the utilization of CRS/HIPEC, however, given limited availability, patients may often be required to travel variable distances prior to therapy. Previous research has described travel bias, whereby greater travel distances are associated with improved surgical outcomes for patients undergoing oncologic resections. We sought to evaluate the possible impact of travel distance on post-surgical outcomes and overall survival in patients undergoing CRS/HIPEC. Methods A retrospective review of data from the multicenter US HIPEC Collaborative database was done. A zip-code centroid model was utilized to categorize patients into three travel areas (<50miles: Near, 50-150miles: Moderate, >250miles: Far). Descriptive analyses of demographic variables and logistic regression for outcome variables was used. A Cox proportional hazards model was performed for survival analysis. Results Demographic differences related to race (p<0.001), gender (p=0.05) and ASA class(p<0.001) were observed. Greater travel distance was associated with a trend toward greater risk of perioperative cardiopulmonary complications(p=0.05); however, no difference in outcomes was observed with respect to overall length of stay, ICU stay, or other surgical complications. On univariate analysis, the furthest travel group was found to have a statistically significant decreased overall survival (Median: 18 vs 22 months). No significant difference in overall survival was found on multivariate analysis. Conclusions Increased travel distances were associated with greater risk of perioperative cardiopulmonary complications and decreased overall survival after CRS/HIPEC, contrary to other data regarding travel bias in cancer surgery. Ongoing studies will need to be undertaken to better delineate this relationship.