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Regionalization of thoracic surgery improves short-term cancer esophagectomy outcomes

	author = {Sora Ely and Amy Alabaster and Simon K. Ashiku and Ashish Patel and Jeffrey B. Velotta},
	title = {Regionalization of thoracic surgery improves short-term cancer esophagectomy outcomes},
	journal = {Journal of Thoracic Disease},
	volume = {11},
	number = {5},
	year = {2019},
	keywords = {},
	abstract = {Background: Some studies have found that outcomes from cancer esophagectomy are better at higher-volume centers than at lower-volume centers. Reports on outcomes following systematic centralization have largely demonstrated subsequent improvements, but these originate in nationalized healthcare systems that are not very comparable to the heterogeneous private-payer systems that predominate in the United States. We examined how regionalization of thoracic surgery to Centers of Excellence (CoE) within our American integrated healthcare system changed overall care for our patients, and whether it changed outcomes. 
Methods: We conducted a retrospective chart review of 461 consecutive patients undergoing cancer esophagectomy between 2009–2016, spanning the 2014 shift to regionalization. High-volume was defined as ≥5 esophagectomies per year. We compared characteristics of the surgeon, hospital, and operation pre- and post-regionalization using Chi-square or Fisher’s exact test for categorical variables and Kruskal-Wallis test for age. We evaluated their associations with patient outcomes with hierarchical linear and logistic mixed models, which adjusted for clustering within surgeon and facility levels and relevant covariates.
Results: While there was no difference in their baseline demographics, patients undergoing esophagectomy post-regionalization were much more likely to have their surgery performed at a designated Center of Excellence (78.8% of cases versus 34.2%, P},
	issn = {2077-6624},	url = {}