Centralized Surgical Care Significantly Improves Patient Outcomes, System Performance

Johnson BA, Moturu A, Eagle S, et al. Effect of Centralized Surgical Care on Performance Outcomes Across Multi-hospital Systems: A Systematic Review. Ann Surg. January 2026.

This systematic review shows that centralization of surgical care within multihospital systems is consistently associated with improved outcomes for complex procedures. 

Across studies, centralization resulted in 15%–40% relative reductions in perioperative mortality, with absolute mortality improvements of 1%–3%, particularly for oncologic, colorectal, hepatopancreatobiliary, and other high-acuity operations. Major morbidity decreased by 10%–30%, and failure-to-rescue rates declined by 15%–25% in systems directing care to high-volume centers. Centralized care was also associated with shorter hospital length of stay (0.5–2.0 days), lower readmission rates (5%–15% relative reduction), and improved compliance with guideline-concordant processes of care.

From a system performance standpoint, centralization produced 25%–60% increases in procedural volume at hub hospitals, improved OR utilization, and higher surgeon- and team-level procedural experience. Several studies demonstrated improvements in composite quality scores and registry-based benchmarks following centralization, with some reporting cost reductions of 5%–20% per episode of care, driven by fewer complications and shorter stays. 

Benefits were most pronounced for procedures with known volume–outcome relationships, while outcomes for low-complexity operations were largely unchanged. The authors emphasize that maximal gains occurred in systems with formal referral pathways, standardized perioperative protocols, and continuous outcomes monitoring, while cautioning that poorly structured centralization may increase travel burden and exacerbate access disparities.