{"entity":{"id":"centralisation","kind":"term","name":"Centralisation and high-volume centres","aka":["centralisation","centralization","centralised","centralized","high-volume centre","high-volume centres","high-volume center","high-volume","volume-outcome","volume–outcome","hospital volume","surgeon volume","specialist centre","referral centre","tertiary centre","expert centre","reference centre","centres of excellence","regionalisation","regionalization","centers of excellence","reference centres","referral centres","specialist centres"],"tldr":"Concentrating complex cancer surgery (oesophagus, pancreas, bladder, liver) and rare cancer care in fewer hospitals that perform each operation often. Hospitals and surgeons with high volumes have fewer deaths and complications, so the Netherlands, Denmark and parts of the UK mandate minimum volumes; patients travel further, and rural access suffers.","summary":"The volume-outcome relationship is among the most robust findings in health services research: mortality after oesophagectomy, pancreatectomy, cystectomy and complex hepatobiliary surgery is roughly halved in high-volume centres, and the Netherlands, Denmark and parts of the UK have mandated minimum volumes. The same logic applies to sarcoma, paediatric cancers, CAR-T and allogeneic transplant, which are delivered only in accredited centres. Costs are travel burden, inequity for rural patients and loss of local skills, which telemedicine, hub-and-spoke networks and shared care (systemic therapy locally, surgery centrally) try to mitigate.","asOf":"2026-09-09","links":[{"label":"Birkmeyer et al., Hospital volume and surgical mortality in the United States (NEJM 2002)","url":"https://doi.org/10.1056/NEJMsa012337"}],"tags":[],"related":["oesophagectomy","whipple","surgical-morbidity","rare-cancers"],"cancers":[],"sections":["surgery"],"technologies":["telemedicine-teleoncology","community-oncology-networks"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-birkmeyer-n-engl-j-med"],"journals":[],"dependsOn":[],"notes":[],"category":"Treatment jargon","wikipediaChecked":"2026-09-22"},"route":"/terms/centralisation/","neighbours":{"term":[{"id":"oesophagectomy","kind":"term","name":"Oesophagectomy","route":"/terms/oesophagectomy/"},{"id":"rare-cancers","kind":"term","name":"Rare cancers","route":"/terms/rare-cancers/"},{"id":"surgical-morbidity","kind":"term","name":"Surgical morbidity and postoperative complications","route":"/terms/surgical-morbidity/"},{"id":"whipple","kind":"term","name":"Whipple procedure (pancreaticoduodenectomy)","route":"/terms/whipple/"}],"section":[{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"technology":[{"id":"community-oncology-networks","kind":"technology","name":"Community oncology and site networks","route":"/technologies/community-oncology-networks/"},{"id":"telemedicine-teleoncology","kind":"technology","name":"Telemedicine, teleoncology, and telepathology","route":"/technologies/telemedicine-teleoncology/"}],"paper":[{"id":"paper-birkmeyer-n-engl-j-med","kind":"paper","name":"Hospital volume and surgical mortality in the United States","route":"/key-papers/paper-birkmeyer-n-engl-j-med/"}]}}