Summary

Although patients over 30 miles away showed a higher severity of illness and a different racial composition compared to those living closer, these factors did not translate into statistically significant differences in readmission rates, specific complications, or patient-reported outcomes.

Abstract

Introduction

Periprosthetic joint infection (PJI) is a leading cause of total joint arthroplasty (TJA) failure, resulting in significant morbidity for affected patients and high resource utilization. Previous studies have suggested that travel distance to a medical facility can influence patient outcomes, with longer travel distances potentially leading to delays in care and increased complications. This study aims to evaluate the impact of travel distance from centers of joint replacements on complications and readmissions in patients undergoing TJA revisions due to PJI.

Methods

A retrospective review was conducted using a database of patients who underwent TJA revision for PJI between 2016 and 2024. Patients who had revisions due to PJI were identified and divided into two groups based on their travel distance to a center for joint replacement: those living under 30 miles away (n=667) and those living over 30 miles away (n=390). Travel distances were calculated using zip code analysis. Distances were computed using latitude and longitude conversions and the haversine formula. Chi-square tests were employed for categorical variables, and t-tests were used for quantitative variables to determine the significance of differences between the two groups.

Results

Demographic variables, including gender, age, body mass index, racial composition (non-black), and insurance payor type, were similar (P > 0.05) between the under 30 miles (n = 667) and over 30 miles (n = 390) groups. The under-30-miles group consisted of 352 knee revisions (53%) and 315 hip revisions (47%), while the over-30-miles group had 210 knee revisions (54%) and 180 hip revisions (46%). The severity of illness index was significantly different between the groups, with patients traveling more than 30 miles having an index of 2.44 vs. 2.31 for patients within 30 miles (P < 0.05). Additionally, 33% of the patients in the under 30 miles group were discharged to a skilled nursing facility (SNF) compared to 27% of patients over 30 miles (P < 0.05). Readmission rates at 7 days approached statistical significance (5.25% vs. 2.82%, P = 0.06), while 30-day readmission rates did not differ significantly (15.59% vs. 15.38%, P > 0.05). Specific complications, such as sepsis, were more frequent in the over 30 miles group (18% vs. 16%), though not statistically significant (P > 0.05).

Conclusion

This study suggests that travel distance does not significantly affect short-term complications and readmissions in patients undergoing TJA revisions due to PJI. Although patients over 30 miles away showed a higher severity of illness and a different racial composition compared to those living closer, these factors did not translate into statistically significant differences in readmission rates, specific complications, or patient-reported outcomes. The data showed that more patients were being discharged to skilled nursing facilities (SNF) in the under 30 miles traveled group.