Does Centralization of High-Risk Cancer Surgery in Hospital Systems Improve Outcomes?


Key Points

  • Increased centralization was associated with better short-term outcomes for pancreatectomy, esophagectomy, and lung resection.
  • Centralization was not associated with better outcomes for colectomy or proctectomy.

In a study reported in the Journal of Clinical Oncology, Sheetz et al identified the degree of centralization of high-risk cancer surgeries within hospital systems and found improved short-term outcomes with increased centralization among Medicare patients.

Study Details

The study involved merging of 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. The degree to which hospital systems centralized each procedure was derived by calculating the annual proportion of surgeries performed at the highest-volume hospital within each system. The effect of centralization on incidence of postoperative complications, death, and readmissions was assessed in analysis accounting for patient, hospital, and system characteristics. The number of hospital systems in which the specified procedures were performed ranged from 287 to 358.

Centralization and Outcomes

The average degree of centralization by procedure was 25.2% for colectomy, 33.4% for proctectomy, 39.0% for lung resection, 51.3% for esophagectomy, and 71.2% for pancreatectomy. Greater centralization was associated with lower rates of postoperative complications and death for pancreatectomy, esophagectomy, and lung resection; for each 20% increase in degree of centralization within systems, there was an absolute reduction in any complications of 1.6%, 1.5%, and 0.7% for the three procedures, respectively, and an absolute decrease in 30-day mortality of 1.1%, 1.2%, and 0.3%. Independent of volume and hospital quality, 30-day mortality for pancreatectomy was twice as high in the least centralized systems vs the most centralized systems (8.9% vs 3.7%, P < .01); the respective figures were 10.3% vs 4.8% for esophagectomy and 5.4% vs 3.7% for lung resection. Increased centralization was not associated with better outcomes for colectomy or proctectomy. 

The investigators concluded, “Greater 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.”

Kyle H. Sheetz, MD, of the Center for Health-Care Outcomes and Policy, University of Michigan School of Medicine, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by National Institutes of Health grants. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.