{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T23:48:38Z","timestamp":1769125718420,"version":"3.49.0"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T00:00:00Z","timestamp":1710288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the association between travel distance and postoperative length of stay (LOS) and discharge disposition among veterans undergoing surgical aortic valve replacement (SAVR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources\/Study Setting<\/jats:title><jats:p>We performed a retrospective cohort study of patients undergoing SAVR, with or without coronary artery bypass grafting (CABG) at VA Boston Healthcare (January 1, 2005\u2013December 31, 2015).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Postoperative LOS and discharge disposition were compared for SAVR patients based on travel distance to the facility: &lt;100\u2009miles or \u2265100\u2009miles. Multivariable regression was performed to ascertain factors associated with LOS and home discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection\/Extraction Methods<\/jats:title><jats:p>Data were collected via chart review. All patients undergoing SAVR at our institution who primarily resided within the defined region were included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>Of 597 patients studied, 327 patients underwent isolated SAVR; 270 patients underwent SAVR\/CABG. Overall median (IQR) distance between the patient's residence and the hospital was 49.95\u2009miles (27.41\u2013129.94\u2009miles); 190 patients (32%) resided further than 100\u2009miles away. There were no differences in the proportion of patients with diabetes, hypertension, chronic obstructive pulmonary disease (COPD), cerebrovascular disease, atrial fibrillation, or prior myocardial infarction between groups. Overall LOS (IQR) was 9 (7\u201313) days and did not differ between groups (<jats:italic>p<\/jats:italic>\u2009=\u20090.18). The proportion of patients discharged home was higher among patients who resided more than 100\u2009miles from the hospital (71% vs. 58%, <jats:italic>p<\/jats:italic>\u2009=\u20090.01). On multivariable analysis, residing further than 100\u2009miles from the hospital was independently associated with home discharge (OR\u2009=\u20091.64, 95% CI: 1.09\u20132.48). Travel distance was not associated with LOS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Based on our institutional experience, potential concerns of longer hospital stay or discharge to other inpatient facilities for geographically distanced patients undergoing SAVR do not appear supported. Continued examination of the drivers underlying the marked shift of veterans to the private sector appears warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.14296","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T07:48:20Z","timestamp":1710316100000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Travel distance and outcomes after surgical aortic valve among veterans"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1208-8025","authenticated-orcid":false,"given":"Brendin R.","family":"Beaulieu\u2010Jones","sequence":"first","affiliation":[{"name":"Department of Surgery Boston Medical Center  Boston Massachusetts USA"},{"name":"VA Boston Healthcare System  West Roxbury Massachusetts USA"},{"name":"Department of Surgery Boston University Chobanian &amp; Avedisian School of Medicine  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noah","family":"Siegel","sequence":"additional","affiliation":[{"name":"Boston University Chobanian &amp; Avedisian School of Medicine  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loreski","family":"Collado","sequence":"additional","affiliation":[{"name":"Department of Surgery Boston Medical Center  Boston Massachusetts USA"},{"name":"VA Boston Healthcare System  West Roxbury Massachusetts USA"},{"name":"Department of Surgery Boston University Chobanian &amp; Avedisian School of Medicine  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hillary J.","family":"Mull","sequence":"additional","affiliation":[{"name":"Department of Surgery Boston University Chobanian &amp; Avedisian School of Medicine  Boston Massachusetts USA"},{"name":"Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacquelyn A.","family":"Quin","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System  West Roxbury Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,3,13]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313481908500918"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/JOCS.15201"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/S11605\u2010019\u201004162\u20108"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/JAMA.2014.2520"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010018\u20104574\u20108"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/106286060201700405"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/S12913\u2010018\u20103108\u20108"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1526924818765811"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.UROLOGY.2017.12.014"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/BJSOPEN\/ZRAC032"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/S11695\u2010015\u20102033\u20108"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/JBCR\/IRAC112"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000082"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/JAMACARDIO.2017.4843"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005732"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/JOCS.14199"},{"key":"e_1_2_10_18_1","unstructured":"US Department of Veterans Affairs.Veterans Access Choice and Accountability Act of 2014 \u2010 Fact Sheet.https:\/\/www.va.gov\/opa\/choiceact\/documents\/Factsheets\/Factsheet_Choice_Act_Fact_Sheet_on_VCP.pdf"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/JAMASURG.2022.4978"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/JAMASURG.2021.6488"},{"key":"e_1_2_10_21_1","unstructured":"US Department of Veterans Affairs.VHA Social Work \u2013 Fisher House Program.https:\/\/www.socialwork.va.gov\/fisher.asp"},{"key":"e_1_2_10_22_1","unstructured":"US Department of Veterans Affairs.VAMobile \u2013 VA Video Connect.https:\/\/mobile.va.gov\/app\/va-video-connect"},{"key":"e_1_2_10_23_1","unstructured":"LawrenceQ.VA hospitals are outperforming private hospitals latest Medicare survey shows. 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