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Invited Commentary
April 11, 2018

Regionalization, Readmissions, and Repercussions of Major Cancer Surgery

Author Affiliations
  • 1Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
  • 2Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
JAMA Surg. Published online April 11, 2018. doi:10.1001/jamasurg.2018.0403

Longstanding data noting the volume-outcomes relationship in high-risk surgical procedures has led to ongoing work to realize the implied benefits.1,2 Two main strategies are considered: regionalization to high-volume centers and translation of best practices from high-volume centers to improve care across settings. Resultant increased travel distances from regionalization—an inconvenience when arriving for surgery—presents complex problems for patients at discharge that are magnified if complications occur. As Zafar et al3 found in their work, the benefits of regionalization are tempered because readmissions to local (nonindex) hospitals after major cancer surgery are associated with significantly higher risks of mortality and morbidity. The unintended consequences of regionalization warrant consideration.

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