{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:44:36Z","timestamp":1791935076477,"version":"4.3.4"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Patient proximity to a surgical center is an important consideration in the coordination and delivery of high-quality postoperative care. Implant-based and autologous breast reconstruction require different perioperative resources and may be impacted in a varying manner by distance from the health care center. This study evaluated the impact of geographic distance on clinical and financial outcomes in free flap and implant-based breast reconstruction.<\/jats:p>\n                  <jats:p>A retrospective review was conducted of 176 free flap and 239 implant-based immediate breast reconstructions performed from 2017 to 2023 at a single academic center. Patients were classified by great-circle distance to the medical center as far (\u2265\u200930 miles) or near (&lt;\u200930 miles). Propensity score-matched cohorts were created for free flap (n\u2009=\u200970 pairs) and implant-based (n\u2009=\u200979 pairs) reconstruction, controlling for demographics, comorbidities, treatment variables, and laterality. Clinical outcomes, wound complications, revision procedures, opioid use, hospital resource utilization, and financial measures between near and far patients for each reconstruction type were compared using paired t-tests, McNemar's tests, and exact binomial testing for sparse outcomes.<\/jats:p>\n                  <jats:p>In the flap cohort, near- and far-distance groups did not differ significantly in operative time, length of stay, intensive care use, postoperative communication, emergency department visits, opioid requirements, complication rates, revision procedures, or financial outcomes. Total flap loss and thromboembolic events were rare and did not differ significantly between groups. In the implant-based cohort, there were no significant differences in operative time, length of stay, postoperative communication, emergency department visits, opioid requirements, complication rates, revision procedures, or financial outcomes between groups.<\/jats:p>\n                  <jats:p>Geographic distance was not associated with worse clinical or financial outcomes after immediate breast reconstruction. These findings suggest that high-volume academic centers can deliver consistent reconstructive outcomes across a range of patient proximities.<\/jats:p>","DOI":"10.1055\/a-2972-6028","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T23:11:11Z","timestamp":1791241871000},"source":"Crossref","is-referenced-by-count":0,"title":["A Propensity Score-Matched Analysis of Geographic Distance in Immediate Free Flap and Implant-Based Breast Reconstruction"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6765-818X","authenticated-orcid":false,"given":"Benjamin G.","family":"Ke","sequence":"additional","affiliation":[{"name":"University of Virginia Health System, Virginia, United States","place":["Charlottesville"],"department":["Department of Plastic Surgery, Maxillofacial and Oral Health"]},{"name":"Darden School of Business, University of Virginia, Virginia, United States","place":["Charlottesville"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"DeVito","sequence":"additional","affiliation":[{"name":"University of Virginia Health System, Virginia, United States","place":["Charlottesville"],"department":["Department of Plastic Surgery, Maxillofacial and Oral Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aqiyl","family":"Mills","sequence":"additional","affiliation":[{"name":"University of Virginia Health System, Virginia, United States","place":["Charlottesville"],"department":["Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi N.","family":"Ghahrai","sequence":"additional","affiliation":[{"name":"University of Virginia Health System, Virginia, United States","place":["Charlottesville"],"department":["Department of Plastic Surgery, Maxillofacial and Oral Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Bailey","sequence":"additional","affiliation":[{"name":"University of Virginia Health System, Virginia, United States","place":["Charlottesville"],"department":["Department of Plastic Surgery, Maxillofacial and Oral Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hibo M.","family":"Wehelie","sequence":"additional","affiliation":[{"name":"University of Virginia Health System, Virginia, United States","place":["Charlottesville"],"department":["Department of Plastic Surgery, Maxillofacial and Oral Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"Wen","sequence":"additional","affiliation":[{"name":"University of Virginia Health System, Virginia, United States","place":["Charlottesville"],"department":["Department of Plastic Surgery, Maxillofacial and Oral Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott T.","family":"Hollenbeck","sequence":"additional","affiliation":[{"name":"University of Virginia Health System, Virginia, United States","place":["Charlottesville"],"department":["Department of Plastic Surgery, Maxillofacial and Oral Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Stranix","sequence":"additional","affiliation":[{"name":"University of Virginia Health System, Virginia, United States","place":["Charlottesville"],"department":["Department of Plastic Surgery, Maxillofacial and Oral Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris A.","family":"Campbell","sequence":"additional","affiliation":[{"name":"University of Virginia Health System, Virginia, United States","place":["Charlottesville"],"department":["Department of Plastic Surgery, Maxillofacial and Oral Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"10","key":"ref1","doi-asserted-by":"crossref","first-page":"e223633","DOI":"10.1001\/jamahealthforum.2022.3633","article-title":"Disparities in spatial access to emergency surgical services in the US","volume":"3","author":"M L McCrum","year":"2022","journal-title":"JAMA Health Forum"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.jss.2025.04.049","article-title":"Association between patient travel time and postoperative complications in a broad surgical population","volume":"311","author":"H Kadri","year":"2025","journal-title":"J Surg Res"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.jamcollsurg.2016.12.017","article-title":"Access to quaternary care surgery: implications for accountable care organizations","volume":"224","author":"J H Mehaffey","year":"2017","journal-title":"J Am Coll Surg"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/j.amjsurg.2023.02.010","article-title":"Geographic access to care and pediatric surgical outcomes","volume":"225","author":"H Cockrell","year":"2023","journal-title":"Am J Surg"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1097\/MLR.0000000000000082","article-title":"Travel distance and health outcomes for scheduled surgery","volume":"52","author":"S Chou","year":"2014","journal-title":"Med Care"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"203e","DOI":"10.1097\/PRS.0000000000002343","article-title":"Distance to a plastic surgeon and type of insurance plan are independently predictive of postmastectomy breast reconstruction","volume":"138","author":"M C Roughton","year":"2016","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/PRS.0000000000001847","article-title":"The impact of travel distance on breast reconstruction in the United States","volume":"137","author":"C R Albornoz","year":"2016","journal-title":"Plast Reconstr Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"101819","DOI":"10.1016\/j.jth.2024.101819","article-title":"Impact of distance and\/or travel time on healthcare service access in rural and remote areas: a scoping review","volume":"37","author":"E P Mseke","year":"2024","journal-title":"J Transp Health"},{"issue":"09","key":"ref9","doi-asserted-by":"crossref","first-page":"6629","DOI":"10.1245\/s10434-025-17694-y","article-title":"The impact of travel distance on patient outcomes after breast reconstruction","volume":"32","author":"J Levy","year":"2025","journal-title":"Ann Surg 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geographical access challenges on outcomes of postmastectomy breast reconstruction","volume":"7","author":"M L Silverstein","year":"2023","journal-title":"Ann Breast Surg"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.jpeds.2021.03.026","article-title":"Influence of geographic access on surgical center readmissions after index congenital heart surgery","volume":"234","author":"N M Pinto","year":"2021","journal-title":"J Pediatr"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1080\/13561820.2020.1712332","article-title":"Relational coordination in inter-organizational settings. How does lack of proximity affect coordination between hospital-based and community-based healthcare providers?","volume":"35","author":"S Bligaard Madsen","year":"2021","journal-title":"J Interprof Care"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1001\/jamasurg.2014.2071","article-title":"Care fragmentation in the postdischarge period: surgical readmissions, distance of travel, and postoperative mortality","volume":"150","author":"T C Tsai","year":"2015","journal-title":"JAMA Surg"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.amjsurg.2018.09.016","article-title":"\u201cAre we there yet?\u201d- factors affecting postoperative follow-up after general surgery procedures","volume":"216","author":"K Harkey","year":"2018","journal-title":"Am J Surg"},{"issue":"14","key":"ref18","doi-asserted-by":"crossref","first-page":"2555","DOI":"10.3390\/cancers16142555","article-title":"Enhancing post-mastectomy care: telehealth's impact on breast reconstruction accessibility for breast cancer patients","volume":"16","author":"S A Stearns","year":"2024","journal-title":"Cancers (Basel)"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2972-6028.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:48:34Z","timestamp":1791931714000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2972-6028"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":18,"URL":"https:\/\/doi.org\/10.1055\/a-2972-6028","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10,5]]},"published":{"date-parts":[[2026,10,5]]}}}