Context Given the strong volume-outcome relationships observed with many surgical
procedures, restricting some procedures to hospitals exceeding a minimum volume
standard is advocated. However, such regionalization policies might cause
unreasonable travel burdens for surgical patients.
Objective To estimate how minimum volume standards for esophagectomy and pancreatic
resection would affect how long patients must travel for these procedures.
Design, Setting, and Patients Simulated trial based on Medicare claims and US road network data. All
US hospitals in the 48 continental states were in the study if their surgical
procedures included esophagectomy and pancreatic resection. Data from Medicare
patients (N = 15 796) undergoing these 2 procedures for cancer between
1994 and 1999 were used.
Main Outcome Measure Additional travel time for patients required to change to higher-volume
centers as a result of alternative hospital volume standards (procedures per
Results With low-volume standards (1/year for pancreatectomy; 2/year for esophagectomy),
approximately 15% of patients would change to higher-volume centers, with
negligible effect on their travel times. Most patients would need to travel
less than 30 additional minutes (74% pancreatectomy; 76% esophagectomy). Many
patients already lived closer to a higher-volume hospital (25% pancreatectomy;
26% esophagectomy). Conversely, with very high-volume standards (>16/year
for pancreatectomy; >19/year for esophagectomy), approximately 80% of patients
would change to higher-volume centers. More than 50% of these patients would
increase their travel time by more than 60 minutes. Travel times would increase
most for patients living in rural areas.
Conclusions Many patients travel past a higher-volume center to undergo surgery
at a low-volume hospital. If not set too high, hospital volume standards could
be implemented for selected operations without imposing unreasonable travel
burdens on patients.