Emergency healthcare access is a critical quality measurement for treating sudden surgical conditions that affect 10% of U.S. hospitalizations. Delayed care produces more serious problems like appendicitis perforation. Although the World Bank specifies journey time as a measuring instrument its applicability in the US has not been investigated.
This study evaluates the relationship between delayed presentations in surgical crises and the amount of time to get emergency treatment. Regionalization and federal policies change, as the findings are intended to assist policymakers in evaluating the impact of hospital closures and refining plans for enhancing access to emergency treatment.
Researchers performed this cohort study to strengthen the reporting of observational studies in epidemiology (STROBE) guidelines and gained approval from the University of Washington’s institutional review board. This study applied the 2021 de-identified Healthcare Cost and Utilization Project (HCUP) State Inpatient and Emergency Department Databases from Florida and California that covered 97% of hospital discharges in both states.
The study selected patients aged 18 and older who received emergency general surgery treatments for appendicitis, cholecystitis, diverticulitis, hernia or bowel obstruction by international classification of diseases (ICD)-10 codes. The essential details like age, gender, race, insurance status and any additional medical conditions were recorded.
The main exposure measured was travel time from a patient’s residence to a hospital. The time was split into five intervals for analysis. The team used population-weighted location data to estimate travel times between home zip codes and hospital addresses using American Hospital Association Annual Survey database records. The disease complexity during the initial visit served as the primary outcome a result, which divided the ICD-10 based on higher and lower categories.
Secondary outcomes included clinical and healthcare resource utilization such as mortality, complications, surgical interventions, total charges and length of stay. Multivariable logistic regression models with and without adjustment for other covariates were employed to assess relationships between travel time and outcomes. Sensitivity analyses explored the different specifications of the model.
Data of 190,311 patients levels an age range distribution that 41.4% of the patients were aged between 40 to 64, 52.9% of the patients were women, 31.3% of the patients were Hispanics and 51.2% of the patients were non-Hispanic Whites. Incidence of patients (96.2% travelled from the hospital in less than 60 min, 3.8% travelled from the hospital in more than 60 min). Sociodemographic characteristics were similar across various travel time groups.
Time of travel was associated with increased odds of complex surgical pathology at presentation. 21.2% of patients who travelled more than 120 minutes greater presented with complex conditions (adjusted Odds Ratio) aOR 1.28 [95% confidence interval (CI) 1.17-1.40]. Rurality did not continue to be a unique predictor of disease complexity after accounting for travel time (aOR 0.83, 95% CI 0.75-0.92).
In contrast, people with greater transport times for more than 60 minutes experienced much greater odds of complicated disease (19%), interfacility transfer (32%), surgical management (17%), and admission (41%). They travelled for a while (0.47 days) and a bigger amount of money ($8284) in comparison with travelling for a short time (0.47 days).
This study found that patients with longer travel times to emergency care were more likely to present with higher complexity surgical conditions by suggesting delays in reaching care may hinder timely treatment.
The limitations of the study were the possibility of HCUP errors in diagnosis due to the inaccuracies in ICD-10 coding but these were rectified using validated coding systems. Even though it was conducted in two states which are different from each other, there are still gaps that require focus on the wider scope of research. It is further emphasized on driving time only and did not consider other transportation hurdles.
In this research, patients who have severe surgical ailments and have long distances to cover for emergency treatment are more likely to reach the medical centre with advanced illnesses which suggests that there are lags in treatment. Prolonged travel distances lead to increased healthcare utilization such as longer hospital stays, additional surgeries, transfers and higher costs. This highlights the need for policies to reduce delays in medical attention, especially in agriculture-based regions.
References: Clark NM, Hernandez AH, Bertalan MS, et al. Travel time as an indicator of poor access to care in surgical emergencies. JAMA Netw Open. 2025;8(1):e2455258. doi:10.1001/jamanetworkopen.2024.55258
