ArticleJournal of clinical oncology : official journal of the American Society of Clinical Oncology2019
Centralization of High-Risk Cancer Surgery Within Existing Hospital Systems.
Article in Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 79 papers, 2 of them syntheses that pooled it.
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The trial behind it
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Who cites it
79 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Impact of Centralizing Esophageal Cancer Surgery at High-Volume Centers on Long-Term Survival: Individual Patient Data Meta-Analysis.Annals of surgical oncology · 2025Pooled it
- Clinical Practice Guideline—Acute and Chronic Pancreatitis.Deutsches Arzteblatt international · 2022Guideline
- [Consequences from the reform of hospital structure for surgery: what does centralization offer university visceral surgery departments?]Chirurgie (Heidelberg, Germany) · 2026Review
- How safe is teaching of highly specialized rectal surgery? A propensity score-matched 10-year cohort study.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2026Article
- Inter-institutional heterogeneity in high-volume esophageal cancer centers: an ancillary study of JCOG1109 (JCOG2308A).Esophagus : official journal of the Japan Esophageal Society · 2026Article
- Debate: why surgery should remain central in the management of locally advanced (Stage III) non-small-cell lung cancer.BJC reports · 2026Article
- Viability of Successful Vaginal Delivery in Triplet Pregnancies: A Retrospective Cohort Study Over 20 Years.Birth (Berkeley, Calif.) · 2026Article
- "You're the person for me:" patient perceptions of cancer care team selection and experiences with care coordination within a rural hub-and-spoke health system.Cancer causes & control : CCC · 2026Article
- Improved Survival with Delayed Surgery at High-Volume Centers Versus Early Surgery at Low-Volume Centers for Pancreatic Cancer.Annals of surgical oncology · 2026Article
- The impact of best practice meetings on clinical outcomes in surgical and oncological care: a scoping review.Journal of thoracic disease · 2026Review
- The Financial Argument for Centralization of Care for Esophagectomy.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2026Article
- Volume over location: prioritizing case volume over regional distribution in ovarian cancer treatment.Journal of gynecologic oncology · 2026Article
- Increase in Pancreatoduodenectomy Volume at Mid-Volume Facilities in the United States: A National Cancer Database Analysis.Annals of gastroenterological surgery · 2026Article
- Association Between Fragmentation of Care and Delivery of Adjuvant Chemotherapy in Patients Traveling to High-Volume Hospitals for Pancreatic Adenocarcinoma.Annals of surgical oncology · 2026Article
- Healthcare facility volume and evidence-based practice implementation in surgical care of patients with common cancers.American journal of surgery · 2026Article
- Association between rurality and mortality from major diseases in Japan: an ecological study.BMJ open · 2026Article
- Outcomes Among Medicare Beneficiaries After Cancer Surgery in Hospitals That Subsequently Closed.JAMA network open · 2026Article
- Comparison of utilization trends, outcomes, and costs between open and minimally invasive esophagectomy.Surgical endoscopy · 2025Article
- Surgery at High-Quality Hospitals Among Medicare Advantage Beneficiaries Undergoing Cancer Surgery.JAMA surgery · 2025Article
- Evaluating failure to rescue after esophagectomy: The esophagectomy failure to rescue assessment, trends, and Evaluation (E-FATE) study.JTCVS open · 2025Article
19 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
purposeCentralization is often proposed as a strategy to improve the quality of certain high-risk health care services. We evaluated the extent to which existing hospital systems centralize high-risk cancer surgery and whether centralization is associated with short-term clinical outcomes. PATIENTS AND
methodsWe merged data from the American Hospital Association's annual survey on hospital system affiliation with Medicare claims to identify patients undergoing surgery for pancreatic, esophageal, colon, lung, or rectal cancer between 2005 and 2014. We calculated the degree to which systems centralized each procedure by calculating the annual proportion of surgeries performed at the highest-volume hospital within each system. We then estimated the independent effect of centralization on the incidence of postoperative complications, death, and readmissions after accounting for patient, hospital, and system characteristics.
resultsThe average degree of centralization varied from 25.2% (range, 6.6% to 100%) for colectomy to 71.2% (range, 8.3% to 100%) for pancreatectomy. Greater centralization was associated with lower rates of postoperative complications and death for lung resection, esophagectomy, and pancreatectomy. For example, there was a 1.1% (95% CI, 0.8% to 1.4%) absolute reduction in 30-day mortality after pancreatectomy for each 20% increase in the degree of centralization within systems. Independent of volume and hospital quality, postoperative mortality for pancreatectomy was two times higher in the least centralized systems than in the most centralized systems (8.9%
conclusionGreater centralization of complex cancer surgery within existing hospital systems was associated with better outcomes. As hospitals affiliate in response to broader financial and organization pressures, these systems may also present unique opportunities to improve the quality of high-risk cancer care.
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