CHICAGO — Nearly one in eight children undergoing a common inpatient surgical procedure lived more than 60 miles from the hospital where they received care. These children had higher odds of complications, longer hospital stays, and higher hospital charges than children who lived closer, according to a study published in the Journal of the American College of Surgeons (JACS).
The findings come as pediatric surgical care becomes increasingly concentrated at larger hospitals and specialized children’s hospitals, requiring some families to travel far even for common procedures.
Using 2018–2021 inpatient data from 12 states, researchers analyzed 71,451 children who underwent an appendectomy, gallbladder removal, surgery for pyloric stenosis, inguinal hernia repair, or feeding tube placement. Of these children, 8,594 (12%) lived more than 60 miles from the treating hospital.
Main Study Findings
Compared with children who lived less than 30 miles from the hospital, those who lived more than 60 miles away had:
- 21% higher adjusted odds of complications
- Hospital stays that were about 13% longer
- Hospital charges that were about 9% higher
Children who lived 30 to 60 miles away had hospital stays and charges that were each about 4% higher than those of children living less than 30 miles away.
Children who lived more than 60 miles from the hospital were also younger than those living less than 30 miles away (median age 3 versus 10 years), more likely to live in rural areas (47% versus 5%), and more likely to have been transferred for care (39% versus 13%). The results generally pointed in the same direction when researchers excluded the COVID-19 pandemic years and examined the procedures separately. However, after researchers also accounted for differences between states, the association between distance and complications was no longer statistically significant.
“I think it’s important to understand these findings not as evidence that travel itself causes worse outcomes,” said Reagan Collins, MD, lead author of the study and a surgery resident at the University of Pennsylvania in Philadelphia. “The burden of traveling for care depends in part on the resources available in a family’s state and extends beyond distance to time off work, childcare, and added costs.”
The authors said the findings raise questions about where to preserve or expand pediatric surgical services. Not every procedure requires the same resources: Some children may be able to receive care safely closer to home, while others benefit from referral to a specialized center.
“Many of these families who need to travel for surgical care are experiencing tremendous financial burden, especially if they have to take off work or arrange for childcare for a sibling not being treated at the hospital,” said Cornelia L. Griggs, MD, MPH, FACS, senior author of the study and a pediatric surgeon at Mass General Brigham for Children in Boston. “This data will be helpful as we ask bigger questions about what the pediatric surgical workforce should look like, and as hospitals think about how and where they need to provide pediatric surgical access to patients and families.”
The authors suggest strengthening partnerships between local and regional hospitals, clarifying when children should be referred to specialized centers, and offering transportation, lodging, or telemedicine support when travel is necessary.
The study used the Healthcare Cost and Utilization Project State Inpatient Databases, which does not account for differences in illness severity, surgical complexity, or the pediatric services available at local hospitals. Children with more complex needs may have traveled farther because they required specialized care. Distance was estimated using ZIP codes and may not reflect families’ actual travel time or route. Future studies will examine travel time and patient complexity more closely.
“This research is an important first step for understanding what barriers impact pediatric surgical care and where we can learn to improve care, especially for more vulnerable patients who are traveling far distances,” Dr. Griggs said.
Co-authors are Cody L. Mullens, MD, MPH, MS; Ghadeer N. Shnawa, MBChB; Joselio Rodrigues De Oliveira Filho, MD; Lena Papadakis, BSc; Gopika SenthilKumar, PhD; and Kyle J. Van Arendonk, MD, PhD, FACS.
Disclosures: The authors have no relevant financial conflicts to disclose.
Citation: Collins RA, Mullens CL, Shnawa GN, et al. Association Between Travel Distance and Outcomes for Common Pediatric Surgical Procedures. Journal of the American College of Surgeons. 2026.
Portions of this work were presented at the American Pediatric Surgical Association Annual Meeting, Chicago, Illinois, May 2026.
