Catchment Profile of Large Cochlear Implant Centers in the United States

Objective: To characterize the catchment area and patient profile of large cochlear implant (CI) centers in the United States. Study Design: Multi-institutional retrospective case series. Setting: Tertiary referral CI centers. Methods: Patients who underwent CI surgery at 7 participating CI centers between 2015 and 2020 were identified. Patients’ residential zip codes were used to approximate travel distances and urban vs rural residential areas. Results: Over the 6-year study period (2015-2020), 6313 unique CI surgical procedures occurred (4529 adult, 1784 pediatric). Between 2015 and 2019, CI procedures increased by 43%. Patients traveled a median 52 miles (interquartile range, 21-110) each way; patients treated at rural CI centers traveled greater distances vs those treated at urban centers (72 vs 46 miles, P <.001). Rural residents represented 61% of the patient population and traveled farther than urban residents (73 vs 24 miles, P <.001). Overall, 91% of patients lived within a 200-mile radius of the institution, while 71% lived within a 100-mile radius. In adults, multiple regression analysis redemonstrated an association between greater travel distances and (1) older age at the time of CI and (2) residential rural setting (both P <.001, r² = 0.2). Conclusions: While large CI centers serve geographically dispersed populations, most patients reside within a 200-mile radius. Strategies to expand CI utilization may leverage remote programming, telemedicine, and strategic placement of new centers and satellite clinics to ameliorate travel burden.