Regionalization and Its Alternatives

Stephanie Lumpkin; Karyn Stitzenberg

doi:10.1016/j.soc.2018.05.009

Regionalization and Its Alternatives

Surg Oncol Clin N Am. 2018 Oct;27(4):685-704. doi: 10.1016/j.soc.2018.05.009. Epub 2018 Jul 21.

Authors

Stephanie Lumpkin¹, Karyn Stitzenberg²

Affiliations

¹ Department of Surgery, University of North Carolina, Chapel Hill, NC 27514, USA.
² Department of Surgery, University of North Carolina, Chapel Hill, NC 27514, USA. Electronic address: Karyn.stitzenberg@med.unc.edu.

PMID: 30213413
DOI: 10.1016/j.soc.2018.05.009

Abstract

This article begins by introducing the historical background surrounding the volume-outcomes relationship literature, particularly in complex cancer surgery. The state of evidence surrounding mortality, as well as other outcomes, in relation to both hospital and surgeon procedure volume is synthesized. Where it is understood, the level of adoption of regionalization of various complex surgeries in the United States is also presented. Various controversies are weighed and discussed. Finally, various models of regionalization and proposed alternatives to regionalization from the peer-reviewed literature are presented.

Keywords: Centralization; Regionalization; Surgical oncology; Volume-outcomes relationship.

Publication types

Review

MeSH terms

Clinical Competence
Delivery of Health Care, Integrated / standards*
Health Services Accessibility*
Hospital Mortality / trends*
Humans
Neoplasms / surgery*
Patient Care / standards*
Surgical Oncology / methods*