Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

VOLUME 10 , ISSUE 1 ( January-March, 2023 ) > List of Articles


Is There a Correlation Between the Driving Distance to Healthcare Facilities and Postoperative Complications After Achilles Tendon Rupture Surgical Repair? A Geospatial Study

Karina Mirochnik, Nour Nassour, Joris RH Hendriks, Noopur Ranganathan, Andreea Lucaciu, Gregory R Waryasz

Keywords : Geographic distribution, Geographic information system, Healthcare accessibility, Healthcare equity, Social determinants of health

Citation Information : Mirochnik K, Nassour N, Hendriks JR, Ranganathan N, Lucaciu A, Waryasz GR. Is There a Correlation Between the Driving Distance to Healthcare Facilities and Postoperative Complications After Achilles Tendon Rupture Surgical Repair? A Geospatial Study. J Foot Ankle Surg Asia-Pacific 2023; 10 (1):198-203.

DOI: 10.5005/jp-journals-10040-1277

License: CC BY-NC 4.0

Published Online: 31-12-2022

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Geospatial access to healthcare is defined as the ability of patients to obtain healthcare services based on their locations. Therefore, we aimed to investigate patients’ proximity to healthcare and its correlation with the complications of surgically treated Achilles tendon rupture (ATR) including venous thromboembolism (VTE), rerupture, and wound problems. Methods: We included 426 patients who lived in the United States (US) Tri-State Area with surgically treated for ATR. We used patient and hospital addresses and zip codes to calculate the distances to healthcare centers. The Shapiro–Wilk test was used to determine normal distribution. Mann–Whitney U test was used to compare the groups with and without complication. The point biserial correlation test was used to determine any correlations between driving distance and the incidence of complications (p < 0.05 was considered significant). Results: The average driving distance to the patient’s specific healthcare center was 62.16 ± 76.54 km. There was no significant difference between the distances for patients with and without overall complications (p = 0.65), with and without VTE (p = 0.70), with and without rerupture (p = 0.84), and with and without wound problems (p = 0.36). No correlation between complications and the distance to healthcare centers was found (p = 0.65). Conclusion: Geospatial information is important within the context of healthcare accessibility and can provide crucial guidance to healthcare planning for patients and healthcare policymakers. Although this study showed that driving distance to healthcare facilities did not lead to significantly higher complication rates amongst ATR patients, it does not resolve the need for further studies looking at a larger population and wider geographical segments.

  1. Tarantino D, Palermi S, Sirico F, et al. Achilles tendon rupture: mechanisms of injury, principles of rehabilitation and return to play. J Funct Morphol Kinesiol 2020;5(4):95. DOI: 10.3390/jfmk5040095
  2. Gwynne-Jones DP, Sims M, Handcock D. Epidemiology and outcomes of acute Achilles tendon rupture with operative or nonoperative treatment using an identical functional bracing protocol. Foot Ankle Int 2011;32(4):337–343. DOI: 10.3113/FAI.2011.0337
  3. Leppilahti J, Puranen J, Orava S. Incidence of Achilles tendon rupture. Acta Orthop Scand 1996;67(3):277–279. DOI: 10.3109/17453679608994688
  4. Maempel JF, Clement ND, Mackenzie SP, et al. Socioeconomic deprivation status predicts both the incidence and nature of Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 2022; DOI: 10.1007/s00167-022-07103-2
  5. Xergia SA, Tsarbou C, Liveris NI, et al. Risk factors for Achilles tendon rupture: an updated systematic review. Phys Sportsmed 2022;1–11. DOI: 10.1080/00913847.2022.2085505
  6. McCrum ML, Wan N, Lizotte SL, et al. Use of the spatial access ratio to measure geospatial access to emergency general surgery services in California. J Trauma Acute Care Surg 2021;90(5):853–860. DOI: 10.1097/TA.0000000000003087
  7. Cauley CE, Anderson G, Haynes AB, et al. Predictors of in-hospital postoperative opioid overdose after major elective operations: a nationally representative cohort study. Ann Surg 2017;265(4):702–708. DOI: 10.1097/SLA.0000000000001945
  8. Tighe P, Modave F, Horodyski M, et al. Geospatial analyses of pain intensity and opioid unit doses prescribed on the day of discharge following orthopedic surgery. Pain Med 2020;21(8):1644–1662. DOI: 10.1093/pm/pnz311
  9. Cella D, Yount S, Rothrock N, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS). Med Care 2007;45(5 Suppl 1):S3–S11. DOI: 10.1097/01.mlr.0000258615.42478.55
  10. Wright MA, Adelani M, Dy C, et al. What is the impact of social deprivation on physical and mental health in orthopaedic patients? Clin Orthop Relat Res 2019;477(8):1825–1835. DOI: 10.1097/CORR.0000000000000698
  11. Gulliford M, Figueroa-Munoz J, Morgan M, et al. What does ‘access to health care’ mean? J Health Serv Res Policy 2002;7(3):186–188. DOI: 10.1258/135581902760082517
  12. Davie S, Kiran T. Partnering with patients to improve access to primary care. BMJ Open Qual 2020;9(2):e000777. DOI: 10.1136/bmjoq-2019-000777
  13. Kim CY, Wiznia DH, Hsiang WR, et al. The effect of insurance type on patient access to knee arthroplasty and revision under the affordable care act. J Arthroplasty 2015;30(9):1498–1501. DOI: 10.1016/j.arth.2015.03.015
  14. Pierce TR, Mehlman CT, Tamai J, et al. Access to care for the adolescent anterior cruciate ligament patient with Medicaid versus private insurance. J Pediatr Orthop 2012;32(3):245–248. DOI: 10.1097/BPO.0b013e31824abf20
  15. Mann-Whitney U Test Calculator [Internet]. Social Science Statistics. [cited 2022 Nov 15]. Available from:
  16. Custom Map Creator & Map Maker | Maptive Mapping Software [Internet]. Maptive. [cited 2022 Nov 11]. Available from:
  17. Free Tools | Distance Report | CDX Technologies [Internet]. [cited 2022 Nov 11]. Available from:
  18. Kamel Boulos MN, Peng G, VoPham T. An overview of GeoAI applications in health and healthcare. Int J Health Geogr 2019;18(1):7. DOI: 10.1186/s12942-019-0171-2
  19. Judge A, Welton NJ, Sandhu J, et al. Equity in access to total joint replacement of the hip and knee in England: cross sectional study. BMJ 2010;341:c4092. DOI: 10.1136/bmj.c4092
  20. Butalia S, Patel AB, Johnson JA, et al. Geographic clustering of acute complications and sociodemographic factors in adults with type 1 diabetes. Can J Diabetes 2017;41(2):132–137. DOI: 10.1016/j.jcjd.2016.08.224
  21. Gruca TS, Pyo TH, Nelson GC. Improving rural access to orthopaedic care through visiting consultant clinics. J Bone Joint Surg Am 2016;98(9):768–774. DOI: 10.2106/JBJS.15.00946
  22. Douthit N, Kiv S, Dwolatzky T, et al. Exposing some important barriers to health care access in the rural USA. Public Health 2015;129(6):611–620. DOI: 10.1016/j.puhe.2015.04.001
  23. Broggi MS, Oladeji PO, Whittingslow DC, et al. Rural hospital designation is associated with increased complications and resource utilization after primary total hip arthroplasty: a matched case-control study. J Arthroplasty 2022;37(3):513–517. DOI: 10.1016/j.arth.2021.11.006
  24. Anderson TJ, Saman DM, Lipsky MS, et al. A cross-sectional study on health differences between rural and non-rural U.S. counties using the County Health Rankings. BMC Health Serv Res 2015;15(1):441. DOI: 10.1186/s12913-015-1053-3
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.