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Effect of Centralized Surgical Care on Performance Outcomes Across Multi-hospital Systems: A Systematic Review
Brett A Johnson1,2, Anoosha Moturu1,3, Shelby Eagle1
1Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.
Annals of Surgery
|August 12, 2025
Summary
Centralizing complex surgical care improves patient outcomes and operational efficiency in multi-hospital systems. However, centralizing noncomplex procedures shows limited benefits and can decrease efficiency.
Area of Science:
- Health Services Research
- Surgical Care Delivery
- Healthcare Management
Background:
- Centralized surgical care is promoted for enhancing value in multi-hospital systems.
- Adoption is inconsistent, and effects across surgical complexity are unclear.
Purpose of the Study:
- Evaluate the impact of centralized surgical care on clinical and operational performance.
- Assess effects across different surgical complexity levels within multi-hospital systems.
Main Methods:
- Systematic review of PubMed, Embase, and Web of Science (inception-January 30, 2025).
- Included hospital-level and system-level comparisons of centralized surgical care.
- Classified surgical care as complex or noncomplex; synthesized findings narratively.
Main Results:
- Centralizing complex surgery improved mortality, complication rates, failure-to-rescue, survival, and adherence to standards.
- Operational benefits included resource utilization, shorter stays, and lower costs.
- Centralizing noncomplex care showed limited clinical benefits and reduced operational efficiency.
Conclusions:
- A selective, complexity-informed approach to organizing surgical care enhances system value.
- Further research on implementation strategies and scalability is needed.
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