复杂外科手术的区域化可能改善医疗质量。我们试图确定区域化对于加州复杂肿瘤手术患者访问高手术量医院的影响。通过2012年至2016年的加州卫生保健访问和信息数据库，我们确定了行食道切除术（ES）、肺切除术（PN）、胰切除术（PA）或直肠切除术（PR）的患者。进行地理空间分析以确定旅行模式。进行集群多变量回归以评估接受高手术量中心护理的概率。在25070名患者中（ES：n ＝1216，4.9%；PN：n ＝13247，52.8%；PD：n ＝3559，14.2%；PR：n ＝7048，28.1%），6575名（26.2%）患者居住在30分钟内，11046名（44.1%）患者居住在30-60分钟内，7125名（28.4%）患者居住在60-90分钟内，324名（1.3%）患者居住在90分钟之外的高手术量中心。中位旅行距离为13.4英里（四分位距[IQR] 6.0-28.7）。多变量回归分析显示，住得离医院距离较远的患者更有可能绕过低手术量中心，在高手术量医院接受护理（比值比1.32，95%置信区间1.12-1.55），相对于住得离高手术量中心较近的人士。约三分之一（29.7%）的患者住在距离最近的高手术量医院1小时的旅行窗口之外，其中5%的患者旅行时间超过90分钟。尽管不同旅行时间窗口内的住院病死率没有差异，但在高手术量中心进行手术与住院病死率整体减少1.2%相关。对于大部分复杂癌症患者来说，区域化复杂癌症手术可能带来相当大的旅行负担。 ©2023.外科肿瘤学会。

Regionalization of complex surgical procedures may improve healthcare quality. We sought to define the impact of regionalization on access to high-volume hospitals for complex oncologic procedures in the state of California.The California Department of Health Care Access and Information Database (2012-2016) identified patients who underwent esophagectomy (ES), pneumonectomy (PN), pancreatectomy (PA), or proctectomy (PR). Geospatial analysis was conducted to determine travel patterns. Clustered multivariable regression was performed to assess the probability of receiving care at a high-volume center.Among 25,070 patients (ES: n = 1216, 4.9%; PN: n = 13,247, 52.8%; PD: n = 3559, 14.2%; PR: n = 7048, 28.1%), 6575 (26.2%) individuals resided within 30 min, 11,046 (44.1%) resided within 30-60 min, 7125 (28.4%) resided within 60-90 min, and 324 (1.3%) resided beyond a 90-min travel window from a high-volume center. Median travel distance was 13.4 miles (interquartile range [IQR] 6.0-28.7). On multivariable regression, patients residing further away were more likely to bypass a low-volume center to undergo care at a high-volume hospital (odds ratio 1.32, 95% confidence interval 1.12-1.55) versus individuals residing closer to high-volume centers. Approximately one-third (29.7%) of patients lived beyond a 1-h travel window to the nearest high-volume hospital, of whom 5% traveled over 90 min. While hospital mortality rates across different travel time windows did not differ, surgery at a high-volume center was associated with an overall 1.2% decrease in in-hospital mortality.Regionalization of complex cancer surgery may be associated with a significant travel burden for a large subset of patients with complex cancer.© 2023. Society of Surgical Oncology.