Demographics of Patients Traveling Notable Distances to Receive Total Knee Arthroplasty

Introduction: Although disparities exist in patient access to and outcomes after total knee arthroplasty (TKA), there are limited data regarding the relationship between travel distance and patient demographics or postoperative complications.

Methods: We identified patients who underwent TKA in Florida and New York between 2006 and 2014 using the Healthcare Cost and Utilization Project State Inpatient Databases. The American Hospital Association and UnitedStatesZipCodes.org Enterprise databases were further used to calculate distance traveled from patient population-weighted zip code centroid points to the hospitals at which they underwent TKA. Patients were grouped by travel distance: 25 to 50, 50 to 100, 100 to 500 miles, and greater than 500 miles. Patient demographic characteristics and postoperative outcomes were compared between the travel distance groups.

Results: Older age, increased medical comorbidities, White race, Medicare insurance coverage, and living in zip codes with greater mean income levels were associated with greater travel distance (P < 0.001). There were no clinically significant relationships between various postoperative complications and distance traveled.

Discussion: Certain demographic variables are associated with increased travel distance to undergo TKA. These relationships were most pronounced at the extremes of distance traveled (>500 miles). These differences may indicate that specific patient groups are either electing to or being forced to travel notable distances for orthopaedic care. Additional research is needed to determine the causative mechanisms underlying these findings.