Introduction: Travel distance to a center performing radical cystectomy (RC) is a well-established risk factor for impaired access to care and care fragmentation. However, the characteristics associated with increased travel for RC remain incompletely defined but are needed to inform efforts to bridge these gaps in care. The objective of this study was to assess features associated with travel distance for RC in a statewide dataset. Methods: The Florida Inpatient Discharge Database was used to identify RC patients from 2013-2019. Travel distance was estimated using zip code centroids and modeled as < 25 miles, 25-50 miles, or > 50 miles. The primary outcome was travel >50 miles for RC. Secondary outcomes included inpatient mortality, discharge to a non-home facility, inpatient complications, and characteristics of hospitals that were bypassed by those traveling. U.S. County Health Rankings were included as model covariates and analyzed by tertile. Mixed effects logistic regression models accounting for clustering within hospitals were utilized. Results: We identified 4209 patients, of whom 2284 (54%) traveled <25 miles, 654 (16%) traveled 25-50 miles, and 1271 (30%) traveled >50 miles. Travel distance >50 miles was associated with treatment at a high-volume center and significantly lower risks of inpatient mortality, non-home discharge, and postoperative complications (all P<0.02). Bypassed hospitals were less likely to be teaching facilities (56% vs. 96%, P<0.001) and more likely to perform =5 RC/year (75% vs. 25%, P<0.001). Following multivariable adjustment, patients who traveled >50 miles were significantly younger (OR 0.98, 95% CI 0.97-1.00), less likely to be Hispanic/Latino (OR 0.35, 95% CI 0.23-0.51), and more likely to reside in a county with the lowest health behavior ranking (OR 6.48, 95% 3.81-11.2) and lowest social economic ranking (OR 7.63, 95% CI 5.30-11.1) compared to those who traveled <25 miles (all P<0.01). Patients who traveled >50 miles primarily lived in central, southeast, or southwest Florida. Conclusions: In Florida, digital outreach aimed to improve care coordination for RC patients would be best targeted in counties with low health behavior and social economic rankings in central and southern Florida. Further work is needed to understand why Hispanic/Latino patients were least likely to travel outside of their local community for RC. SOURCE OF Funding: None
