Dr. Randie White on travel distance and radical cystectomy outcomes

Opinion
Video

“I think one of the most interesting things that we found is that our readmission rate was about 40%,” says Randie White, MD.

In this video, Randie White, MD, shares notable findings from the recent Urology Practice study, “Distance to Treatment with Radical Cystectomy in a Rural State: Long Car Rides, Equivalent Outcomes.” White is a urology resident at Maine Medical Center in Portland.

Transcription:

What were some of the notable findings? Were any of them surprising to you and your coauthors?

We looked at patients who were traveling less than 12.5 miles, between 12.5 and 49 miles, and then greater than 50 miles. Overall, the mean distance was about 60 miles traveled. We looked at postop outcomes. Overall, there wasn't a significant difference between postop outcomes, so length of stay, high-grade or low-grade complications. That was pretty similar among all distances traveled. We believe that this was because we have a pretty strong relationship with our referring urologists. There's a pretty strong integrated EMR amongst the state of Maine. We also have a robust home health services network, a large group of advanced practice providers and triage nurses in our office. So that wasn't too surprising to us. I think one of the most interesting things that we found is that our readmission rate was about 40%. 62% of these were readmitted back to us or back to the treatment center. And of these, high-grade complications tend to be readmitted back to the treatment center or were transferred for further care, whereas low-grade complications tend to be managed at a critical access hospital or an additional hospital. All patients who lived less than 12.5 miles away tended to be managed at outside hospitals. This was the most notable point for us, is that this suggests that regionalization of care can successfully allow for this proper resource allocation and ensure that these patients who do have muscle-invasive bladder cancer who live far away from these high-volume centers can successfully undergo radical cystectomy and not receive substandard care. The additional thing that we looked at in the study that was notable for us was that when we compared patients who are going to neoadjuvant chemotherapy vs going straight to surgery, we didn't find a difference in time to treatment of neoadjuvant chemotherapy based on distance traveled, or between neoadjuvant chemotherapy followed by surgery based on distance traveled, but patients who went straight to surgery did have a delay in treatment based on distance traveled. We believe this is because there are several centers that offer neoadjuvant chemotherapy, but again, there's only 1 academic center that offers radical cystectomy. So I think again, this is an important point for us to just be aware of that there's this 1 center in the state of Maine at this point that's mostly offering radical cystectomy. It's just something to be aware of when we're thinking of pathologic upstaging and delay of care.

This transcript was edited for clarity.

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