This Traffic Will Be The Death Of Me!: A Systematic Review And Meta-Analysis Assessing The Impact Of Travelling To Access Surgery On Postoperative Outcomes In High-Income Countries
Abstract
Objective: To systematically review whether time/distance travelled to access surgery is associated with postoperative outcomes in high-income countries.
Methods: Five databases and relevant grey literature were searched. Risk of bias was not performed; however, included studies were observational and likely highly biased. Articles were qualitatively synthesized in tables and a subset were meta-analyzed using randomeffects models in RevMan.
Results: 138 articles were qualitatively synthesized, and 85 articles were quantitatively synthesized. Aggregate results suggest those who travelled further to access surgery relative to those who did not potentially have lower odds of 30-day (OR 0.67 95% CI 0.56 to 0.81) and 90-day mortality (OR 0.74 95% CI 0.65 to 0.84), but not for other relevant outcomes.
Discussion: Our results suggest that confounders, such as differences in patient baseline risk, socioeconomic status, and centre volume were inadequately explored and must be better addressed to provide comparable travel groups for future analyses.