"We know from previous research that regionalization improves outcomes for trauma and neonatal services, but this is the first study to show the same benefit for elective general surgery."
A move in Maryland toward regionalization -- centralizing particular medical services at centers performing the greatest number -- decreased the death rates for one of the most complex operations for cancer, according to a study by Johns Hopkins researchers published in the July 7, 1998 issue of Annals of Surgery.
In what is believed to be the first study of its kind in the state, researchers examined medical data from 1984 to 1995 from all of Maryland's non-federal acute care hospitals to see if -- and how -- regionalization affected in-hospital deaths for patients undergoing a pancreaticoduodenectomy, a complex, high-risk operation for pancreatic cancer also known as the Whipple procedure.
Throughout the study period, regionalization gained momentum, with 795 of the operations performed at 43 hospitals over the 12-year period. However, one medical center (The Johns Hopkins Hospital) increased its annual share of Whipples from 20.7 percent to almost 60 percent during this period.
At the same time, Maryland's overall in-hospital death rate for the operation dropped from 17.2 percent to 4.9 percent. According to the Hopkins researchers, nearly two-thirds of this reduction (61 percent) was due to the concentration of cases at Hopkins, since the mortality rate for the procedure at Hopkins was 1.8 percent over the 12-year study period versus 14.2 percent for the other Maryland hospitals.
"This study strongly suggests that regionalization of
pancreaticoduodenectomy to one or more high-volume specialized medical centers
in a state saves lives," said Toby Gordon,
Sc.D., associate professor of surgery and Johns Hopkins Medicine vice president.
"It really undersc
Contact: Gary Stephenson
Johns Hopkins Medical Institutions