The impact of developing a comprehensive @entity547 center on the referral patterns and complexity of XXXX care.

@entity1 @entity10688 @entity281 @entity547 @entity4037
BACKGROUND: @entity547 represent a formidable surgical challenge. Several comprehensive @entity547 centers, including ours, with advanced expertise have recently emerged across the country. However, the effects of tertiary specialization remain largely unclear. We aimed to evaluate the impact of developing a comprehensive @entity547 center on the referral patterns and costs of @entity1 with @entity547 . METHODS: A prospectively maintained database was used to identify all @entity1 undergoing open @entity4037 repair (VHR) between 2006 and 2013 at the Case @entity547 . @entity1 were separated into two groups by @entity10688 code: those traveling either <25 or >100 miles. Demographics, operative characteristics, length of stay and costs data were analyzed. RESULTS: Of all @entity1 who underwent open VHR during the study period, 287 met the inclusion criteria. @entity547 , width and area were all significantly larger for @entity1 traveling >100 miles (P  <  0.01 for all). These @entity1 were also more likely to have active mesh infections (OR 3.57) and non-healing wounds (OR 5.00) when compared with local @entity1 . Length of hospital stay was significantly longer for @entity1 traveling >100 miles compared to those traveling <25 miles (9.7 vs. 6.8; P  <  0.0001). Surgical site occurrence, @entity281 and @entity547 recurrence rates were similar between the two groups during the follow-up period. @entity1 who traveled >100 miles incurred significantly higher fixed direct and variable direct costs compared to those who traveled <25 miles (P  <  0.05 for both). CONCLUSION: The development of a comprehensive @entity547 center results in centralization of complex @entity547 care. @entity1 traveling >100 miles for @entity4037 repair have significantly larger and more @entity547 . The implications for improved @entity1 outcomes and potential reimbursement issues for providing this care should be carefully evaluated.
