%0 Journal Article %T Regionalization of thoracic surgery improves short-term cancer esophagectomy outcomes %A Ely, Sora %A Alabaster, Amy %A Ashiku, Simon K. %A Patel, Ashish %A Velotta, Jeffrey B. %J Journal of Thoracic Disease %D 2019 %B 2019 %9 %! Regionalization of thoracic surgery improves short-term cancer esophagectomy outcomes %K %X 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 Conclusions: Regionalization of thoracic surgery in our hospital system resulted in esophagectomies being performed by more experienced surgeons at higher-volume centers, with a concomitant improvement in short-term outcomes. Patients undergoing esophagectomy, particularly MIE, post-regionalization benefited significantly from decreased LOS and perioperative complication rate. Our results suggest that, in a large integrated healthcare system, regionalization significantly improves overall outcomes for patients undergoing cancer esophagectomy. %U https://jtd.amegroups.org/article/view/28893 %V 11 %N 5 %P 1867-1878 %@ 2077-6624