Regionalization of High-Risk Surgery and Implications for Patient Travel Times

摘要: ContextGiven the strong volume-outcome relationships observed with many surgical procedures, restricting some procedures to hospitals exceeding a minimum volume standard is advocated. However, such regionalization policies might cause unreasonable travel burdens for surgical patients.ObjectiveTo estimate how volume standards esophagectomy and pancreatic resection would affect long patients must these procedures.Design, Setting, PatientsSimulated trial based on Medicare claims US road network data. All US in 48 continental states were study if their surgical procedures included pancreatic resection. Data from Medicare patients (N = 15 796) undergoing 2 cancer between 1994 1999 used.Main Outcome MeasureAdditional time required change higher-volume centers as result of alternative hospital (procedures per year).ResultsWith low-volume (1/year pancreatectomy; 2/year esophagectomy), approximately 15% higher-volume centers, with negligible effect times. Most need travel less than 30 additional minutes (74% 76% esophagectomy). Many patients already lived closer (25% pancreatectomy; 26% Conversely, very high-volume (>16/year for >19/year esophagectomy), approximately 80% patients would centers. More 50% would increase by more 60 minutes. Travel times increase most living rural areas.ConclusionsMany past center undergo surgery at hospital. If not set too high, could be implemented selected operations without imposing unreasonable travel burdens patients.