Centralization, or shifting patients to hospitals with the most experience (or best outcomes), through the implementation of volume standards continues to be discussed as a means of improving the safety of high-risk surgical care. High-risk surgery involves operations in which postoperative complications are common or the risk of perioperative death is approximately 1% or greater.1 High-risk operations, such pancreatectomy, lung resection, or complex procedures for colorectal cancer, are performed on hundreds of thousands of patients annually in the US.2 Despite considerable enthusiasm for centralizing high-risk operations at designated centers, it remains unclear whether this delivery model is feasible in the US. Recent work suggests that a very small proportion of US hospitals currently meet established volume standards for high-risk operations set forth by initiatives like “Take the Volume Pledge” and the Leapfrog Group’s evidence-based hospital referral.2,3 Moreover, these standards may not consistently or reliably differentiate hospitals based on commonly measured perioperative quality outcomes.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Sheetz KH, Massarweh NN. Centralization of High-risk Surgery in the US: Feasible Solution or More Trouble Than It Is Worth? JAMA. 2020;324(4):339–340. doi:10.1001/jama.2020.2953
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: