Patient travel burden and postoperative outcomes after lumbar fusion

Background: Geographic barriers to surgical care have been linked to poor postoperative outcomes. Patients living farther from surgical centers may experience delays in care, which may adversely impact postoperative outcomes. While the influence of travel time and distance, or travel burden, on patient outcomes has been examined in other surgical populations, its impact on lumbar fusion is understudied. The authors hypothesize that travel burden represents an independent risk factor for adverse postoperative events following lumbar fusion. Methods: A retrospective cohort study was performed at an academic Level I trauma center examining adult patients who underwent lumbar fusion (L1-L5) from 2013 to 2025. Patients with spinal malignancy, pregnancy, rheumatologic disease, polytrauma, and prior failed fusion were excluded. Travel distance and driving time to the hospital were calculated using Google Maps. Outcomes of interest included postoperative length of stay (LOS) readmissions and surgical, infectious, neurologic, pulmonary, cardiovascular, and thromboembolic complications. Analyses included multivariate Firth penalized logistic regression and multivariate linear regression. Results: The final cohort included 403 patients (mean age 51.4 ± 10.7 years; BMI 30.5 ± 5.9). Mean travel distance and time were 44.4 ± 47.9 miles and 60.2 ± 50.1 minutes respectively. Travel burden was not significantly associated with any postoperative complication or LOS. Conclusions: In this cohort, travel burden was not associated with postoperative complications or length of stay following lumbar fusion. These findings suggest that travel burden alone does not independently constitute a risk factor for poor lumbar fusion outcomes, which may serve to reassure both patients and surgeons, though further validation is warranted.