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Thesis Format



Master of Science


Epidemiology and Biostatistics


Martin, Janet


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.

Summary for Lay Audience

In 2015, the Lancet Commission on Global Surgery (LCoGS) generated goals, and indicators for tracking these goals, for improved access to surgery globally. An important issue this group raised was how living far away from surgical centres may be disadvantageous, especially when people require operations for emergency situations. This idea is somewhat at odds with recent trends in high-income countries towards the centralization of specialized healthcare resources, such as complex surgeries for the treatment of cancer, to urban areas. This thesis aimed to explore how the amount of time spent travelling or distance traversed may influence patient outcomes after surgery, such as death, complication rates, etc.

This thesis systematically searched through academic journals and websites for scientific studies that have assessed how distance or time spent travelling to reach a surgical centre may influence relevant post-surgery health outcomes. After removing irrelevant studies, we were left with 138 studies that fit our search criteria. We summarized the important findings of these studies to answer our research question. We also used statistical methods on a subset of these studies to explore whether the trends were important and if they supported travelling far or short distances/time to access surgery.

Overall, the data suggested those who travelled further to access surgery had reduced mortality after surgery, with similar associations for cancer surgeries, elective surgeries, and those performed in the United States. However, these associations appeared to be partially the result of patient-volume of the surgical centre, whereby busier centres produced better outcomes. Due to data limitations, we were unable to explore whether these results might be better explained by healthier patients being able to travel further for surgery or those with higher socioeconomic status having greater access from a distance. Future research should focus on ensuring comparability of data to allow for valid information on the influence of distance for postoperative outcomes.

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Available for download on Sunday, September 01, 2024

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