A Tale of Two Provinces: Regionalization of Pancreatic Surgery in Ontario and Quebec

Excerpt

Evidence has accumulated over several decades suggesting that high-volume surgeons and hospitals achieve better clinical results with selected surgical procedures.1,2 Volume-outcome relationships are particularly strong for high-risk but infrequently performed procedures such as esophagectomy, hepatic resection, and pancreatic resection, where low-volume providers may perform only a few operations a year. In the United States, efforts to concentrate such procedures in high-volume centers have included selective referral initiatives by payer coalitions, public reporting of hospital caseloads by Internet rating firms, and guidelines from professional organizations.3 However, it remains unclear whether these efforts have been successful in concentrating care or, more importantly, in reducing mortality with high-risk procedures. …