Area-based centralization of pancreatic surgery: a Hub-and-Spoke system balances patient proximity and quality of care.

Area-based centralization optimizes both patient access by minimizing long-distance transfers and enables hospitals to reach adequate surgical volumes to ensure optimal outcomes. This study aimed to analyze a Hub-and-Spoke system applied to pancreatic surgery by evaluating both patient logistics and clinical outcomes. Data from a Hub-and-Spoke system for pancreatic surgery were collected over a 3-year period. The Hub center managed patient referrals from its own region and three additional Spoke hospitals. Clinical decision-making was standardized through dedicated inter-institutional multidisciplinary team meetings. Surgical outcomes and quality metrics were collected and analyzed. Patient transfer patterns related to key steps in the care pathway were retrieved and quantified. Overall, 187 patients underwent surgical exploration at the Hub center, with pancreatic ductal adenocarcinoma as the most common indication (56.1%). A minimally invasive approach was used in 57 (33.1%) patients. Postoperative pancreatic fistula (POPF) rate following pancreaticoduodenectomy was 39.7%, with grade C POPF being 9.0%. The 90-day mortality for the entire cohort was 0.6%, with a failure-to-rescue rate of 2.8%. Textbook outcomes were obtained in 58.1% of cases. The median patient transfer distance from home to the Hub center was 43 kilometers (IQR 25-50), with an estimated travel time of 48 minutes. The cumulative distance required to complete the entire care process was 197 km (IQR 90-225) with an estimated travel time of less than 5 hours. The centralization of pancreatic care through a Hub-and-Spoke system ensured adequate surgical outcomes. Simultaneously, the model maintained patient proximity to care facilities, optimizing access to care pathways and enhancing patient-centered management.