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Hepatobiliary resections are among the most complex and technically challenging surgical procedures. Even though robust evidence showed that complex surgical procedures such as hepatobiliary surgery have better short- and long-term outcomes and lower mortality rate when performed in high-volume centers, the minimal criteria of centers that can perform hepatobiliary activity are not clearly defined. We conducted a retrospective population study of patients who underwent hepatobiliary surgery for malignant disease in a single Italian administrative region (Veneto) from 2010 to 2021 with the aim to investigate the hospitals annual surgical volume for hepatobiliary malignant diseases and the effect of hospital volume on in-hospital, 30- and 90-day postoperative mortality. The centralization process of hepatobiliary surgery in Veneto is rapidly increasing over the past 10 years (rate of performed in highly specialized centers increased from 62% in 2010 to 78% in 2021) and actually it is really established. The crude and adjusted (for age, sex, Charlson Index) mortality rate after hepatobiliary surgery resulted significantly lower in centers with high-volume activity compared to them with low-volume activity. In the Veneto region, the "Hub and Spoke" model led to a progressive centralization of liver and biliary cancer treatment. High surgical volume has been confirmed to be related to better outcomes in terms of mortality rate after hepatobiliary surgical procedures. Further studies are necessary to clearly define the minimal criteria and associated numerical cutoffs that can help define the characteristics of centers that can perform hepatobiliary activities. [ABSTRACT FROM AUTHOR]

Objective  The center of excellence model of health care hypothesizes that increased volume in a specialized center will lead to better and more affordable care. We sought to characterize the volume-outcome data for surgically treated sinonasal and skull base tumors and (chemo) radiation-treated nasopharyngeal malignancy. Design   Systematic review of the literature. Setting  This review included national database and multi-institutional studies published between 1990 and 2019. Participants  PubMed was interrogated for keywords "hospital volume," "facility volume," and outcomes for "Nasopharyngeal carcinoma," "Sinonasal carcinomas," "Pituitary Tumors," "Acoustic Neuromas," "Chordomas," and "Skull Base Tumors" to identify studies. Single-institution studies and self-reported surveys were excluded. Main outcome measures  The main outcome of interest in malignant pathologies was survival; and in benign pathologies it was treatment-related complications. Results  A total of 20 studies met inclusion criteria. The average number of patients per study was 4,052, and ranged from 394 to 9,950 patients. Six of seven studies on malignant pathology demonstrated improved survival with treatment in high volume centers and one showed no association with survival. Ten of thirteen studies on benign disease showed reduced risk of complications, while one study demonstrated both an increased and decreased association of complications. Two studies showed no volume-outcome associations. Conclusion  This systematic review demonstrates that a positive volume–outcome relationship exists for most pathologies of the skull base, with some exceptions. The relative dearth of literature supports further research to understand the effect of centralization of care on treatment outcomes. [ABSTRACT FROM AUTHOR]

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Abstract Background Guidelines recommend treatment of retroperitoneal sarcomas (RPS) at high-volume centers. However, high-volume centers may not be accessible locally. This national study compared outcomes of RPS resection between local low-volume centers and more distant high-volume centers. Methods Patients treated for RPS were identified from the National Cancer Database (1998–2012). Travel distance and annual hospital volume were divided into quartiles. Two groups were identified: (1) short travel to low-volume hospitals (ST/LV), (2) long travel to high-volume hospitals (LT/HV). Outcomes were adjusted for clinical, tumor, and treatment characteristics. Results Two thousand five hundred ninety-nine patients met the inclusion criteria. The LT/HV cohort was younger and more often white (p

Abstract Purpose Most pediatric surgeons perform < 2 esophageal atresia and tracheoesophageal fistula (EA/TEF) repairs annually. We aimed to determine whether higher surgeon and hospital volumes are associated with better outcomes after EA/TEF repair. Methods Neonates with a diagnosis and repair of EA/TEF at their index hospital admission in the Pediatric Health Information System from 1/2000 to 9/2015 were included. For each patient, hospital and surgeon operative volumes were defined as the number of EA/TEF cases treated in the previous 365 days. Propensity score weighting was used to estimate relationships between operative volumes and rates of in-hospital mortality, readmission within 30 days, and readmission, reoperation, and dilation within one year. Results Among 3085 patients, lower birth weight, earlier gestational age, the presence of congenital heart disease, and certain other anomalies were associated with higher mortality. In risk-adjusted analyses, there were no significant differences in mortality or any other outcome based on hospital or surgeon volume alone or when comparing low- or high-volume surgeons practicing at low- or high-volume hospitals. Conclusions Neither surgeon nor hospital volume significantly impacted outcomes after EA/TEF repair. Our findings imply that selective referral and pediatric surgeon subspecialization in EA/TEF may not translate to improved outcomes. Type of study Retrospective comparative study Level of evidence Level III. [ABSTRACT FROM AUTHOR]

Background: An association between volume and outcomes has been observed for esophagectomy, though little is known about why or how patients choose low- or high-volume centers. The purpose of this study was to evaluate how travel burden and hospital volume influence treatment and outcomes of patients with locally advanced esophageal cancer. Methods: Predictors of receiving esophagectomy for patients with T1-3N1M0 mid or distal esophageal cancer in the National Cancer Data Base from 2006 to 2011 were identified using multivariable logistic regression. Survival was compared using propensity score-matched groups: patients in the bottom quartile of travel distance who underwent treatment at low-volume facilities (Local) and patients in the top quartile of travel distance who underwent treatment at high-volume facilities (Travel). Results: Of 4979 patients who met inclusion criteria, we identified 867 Local patients who traveled 2.7 [interquartile range (IQR): 1.6–4 miles] miles to centers that treated 2.6 (IQR: 1.9–3.3) esophageal cancers per year, and 317 Travel patients who traveled 107.1 (IQR: 65–247) miles to centers treating 31.9 (IQR: 30.9–38.5) cases. Travel patients were more likely to undergo esophagectomy (67.8% vs 42.9%, P < 0.001) and had significantly better 5-year survival (39.8% vs 20.6%, P < 0.001) than Local patients. Conclusions: Patients who travel longer distances to high-volume centers have significantly different treatment and better outcomes than patients who stay close to home at low-volume centers. Strategies that support patient travel for treatment at high-volume centers may improve esophageal cancer outcomes. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present study is to examine whether surgical repairs for craniosynostosis have been regionalized to teaching hospitals over the 8-year period from 2003 to 2010. Design: Retrospective analysis of hospital discharge database. Setting: Nationwide Inpatient Sample for years 2003 to 2010. All patients aged up to 3 years who had a surgical repair for craniosynostosis were selected. Interventions: Surgical repair for craniosynostosis. Main Outcome Measures: Performance of surgery in a teaching hospital. Results: During the study period (years 2003 to 2010), a total of 19,417 patients aged up to 3 years underwent a surgical repair for craniosynostosis. The number of surgical procedures increased during the study period. It ranged from 1628 procedures in year 2003 to 3001 procedures during 2010. Data show that 83.3% of all procedures in 2003 were performed in teaching hospitals; whereas, 97.5% of procedures in 2010 were performed in teaching hospitals. Following adjustment for patient-level factors, year 2010 was associated with increased odds of having the surgical procedures performed in a teaching hospital as opposed to a nonteaching hospital when compared with year 2003 (odds ratio = 10.43, 95% confidence interval, 1.10 to 98.98; P = .04). Conclusions: An increasing proportion of surgical repairs of craniosynostosis are performed in teaching hospitals, suggesting there is an increasing concentration of these complex surgical procedures in select centers. As more longitudinal data become available, the relative benefits and drawbacks associated with regionalization of surgical repairs of craniosynostosis should be examined. [ABSTRACT FROM AUTHOR]

The positive relationship between volume and outcome in hepatobiliary surgery has been demonstrated for many years. As for other complex surgical procedures, both improved short- and long-term outcomes have been associated with a higher volume of procedures. However, whether the centralization of complex hepatobiliary procedures makes full sense because it should be associated with higher quality of care, as reported in the literature, precise criteria on what to centralize, where to centralize, and who should be entitled to perform complex procedures are still missing. Indeed, despite the generalized consensus on centralization in hepatobiliary surgery, this topic remains very complex because many determinants are involved in such a centralization process, of which some of them cannot be easily controlled. In the context of different health systems worldwide, such as national health systems and private insurance, there are different stakeholders that demand different needs: politicians, patients, surgeons, institutions and medical associations do not always have the same needs. Starting from a review of the literature on centralization in hepatobiliary surgery, we will propose some guidelines that, while not data-driven due to low evidence in the literature, will be based on good clinical practice., (2020, National Center for Global Health and Medicine.)

Background: Guidelines recommend treatment of retroperitoneal sarcomas (RPS) at high-volume centers. However, high-volume centers may not be accessible locally. This national study compared outcomes of RPS resection between local low-volume centers and more distant high-volume centers. Methods: Patients treated for RPS were identified from the National Cancer Database (1998–2012). Travel distance and annual hospital volume were divided into quartiles. Two groups were identified: (1) short travel to low-volume hospitals (ST/LV), (2) long travel to high-volume hospitals (LT/HV). Outcomes were adjusted for clinical, tumor, and treatment characteristics. Results: Two thousand five hundred ninety-nine patients met the inclusion criteria. The LT/HV cohort was younger and more often white (p < 0.01). The LT/HV group had more comorbidities, higher tumor grade, and more often radical resections and radiotherapy (all p < 0.05). The ST/LV group underwent significantly more R2 resections (4.4% vs. 2.6%, p = 0.003). Thirty-day mortality was significantly lower in the LT/HV group (1.2% vs. 2.8%, p = 0.0026). Five-year survival was better among the LT/HV group (63% vs. 53%, p < 0.0001). After adjustment, the LT/HV group had a 27% improvement in overall survival (HR 0.73, p = 0.0009). Conclusions: This national study suggests that traveling to high-volume centers for the treatment of RPS confers a significant short-term and long-term survival advantage, supporting centralized care for RPS. [ABSTRACT FROM AUTHOR]

Objective The objective of the present study is to examine whether surgical repairs for craniosynostosis have been regionalized to teaching hospitals over the 8-year period from 2003 to 2010. Design Retrospective analysis of hospital discharge database. Setting Nationwide Inpatient Sample for years 2003 to 2010. All patients aged up to 3 years who had a surgical repair for craniosynostosis were selected. Interventions Surgical repair for craniosynostosis. Main Outcome Measures Performance of surgery in a teaching hospital. Results During the study period (years 2003 to 2010), a total of 19,417 patients aged up to 3 years underwent a surgical repair for craniosynostosis. The number of surgical procedures increased during the study period. It ranged from 1628 procedures in year 2003 to 3001 procedures during 2010. Data show that 83.3% of all procedures in 2003 were performed in teaching hospitals; whereas, 97.5% of procedures in 2010 were performed in teaching hospitals. Following adjustment for patient-level factors, year 2010 was associated with increased odds of having the surgical procedures performed in a teaching hospital as opposed to a nonteaching hospital when compared with year 2003 (odds ratio = 10.43, 95% confidence interval, 1.10 to 98.98; P = .04). Conclusions An increasing proportion of surgical repairs of craniosynostosis are performed in teaching hospitals, suggesting there is an increasing concentration of these complex surgical procedures in select centers. As more longitudinal data become available, the relative benefits and drawbacks associated with regionalization of surgical repairs of craniosynostosis should be examined.