BETHESDA, MD — Is it better to transport MHS pediatric patients with congenital heart disease to a high-volume center for care or treat them where they are, even if it is a rural area?
That was the question addressed in a recent study led by Walter Reed National Military Medical Center and the Uniformed Services University of the Health Sciences, both in Bethesda, MD.
“Congenital heart disease (CHD) is a common and significant birth defect, frequently requiring surgical intervention,” the authors wrote in BMC Cardiovascular Disorders. “For beneficiaries of the Department of Defense, a new diagnosis of CHD may occur while living at rural duty stations. Choice of tertiary care center becomes a function of geography, referring provider recommendations, and patient preference.”
The researchers used billing data from the MHS over a five-year period. They compared outcomes for beneficiaries age 10 and younger undergoing CHD surgery by patient origin (rural vs. urban residence) and the distance to treatment (patient’s home and the treating tertiary care center).
The beneficiaries include children of active duty, activated reserves and federally activated National Guard servicemembers. The study adjusted analysis of the outcomes for procedure complexity risk and further stratified treatment centers by annual case volume and whether they publicly reported results in the society of thoracic surgery (STS) outcomes database.
“While increasing distance was associated with the cost of admission, there was no associated risk of inpatient mortality, one-year mortality or increased length of stay,” the authors reported. “Likewise, rural origination was not significantly associated with target outcomes. Patients traveled farther for STS-reporting centers (STS-pr), particularly high-volume centers. Such high-volume centers (>50 high complexity cases annually) demonstrated decreased one-year mortality, but increased cost and length of stay.”
The researchers suggested that their findings “contribute to the national conversation of rural community medicine versus regionalized subspecialty care; separation of patients between rural areas and more urban locations for initial CHD surgical care does not increase their mortality risk. In fact, traveling to high volume centers may have an associated mortality benefit.”
- Millen SM, Olsen CH, Flanagan RP, Scott JS, Dobson CP. The effect of geographic origin and destination on congenital heart disease outcomes: a retrospective cohort study. BMC Cardiovasc Disord. 2023 Feb 22;23(1):99. doi: 10.1186/s12872-023-03037-w. PMID: 36814200; PMCID: PMC9945673.