The effects of regionalization on cost and outcome for one general high-risk surgical procedure

Ann Surg. 1995 Jan;221(1):43-9. doi: 10.1097/00000658-199501000-00005.


Purpose: The effects of regionalization of tertiary care were studied by analyzing cost and outcome for pancreaticoduodenectomies in a state in which the majority of these high-risk procedures were performed in one hospital.

Methods: Using Maryland inpatient discharge data via a retrospective study, the authors compared cost and outcome data for a hospital with more than one half of the cases in the state to all other hospital providers as a group and with smaller groupings according to the volume of procedures performed.

Results: Hospital mortality, length of stay, and costs were significantly less at the high-volume regional medical center when compared with all other hospitals. Mortality and cost increased as volume decreased when hospitals were grouped according to volume.

Conclusions: An academic medical center, functioning as a high-volume regional provider, can deliver tertiary care services with improved outcomes at lower costs than community hospitals.

MeSH terms

  • Academic Medical Centers / economics
  • Aged
  • Female
  • Hospital Costs*
  • Hospital Mortality
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Pancreaticoduodenectomy / economics*
  • Pancreaticoduodenectomy / mortality
  • Regional Medical Programs / economics*
  • Retrospective Studies
  • Risk Factors