Is It Time to Centralize High-risk Cancer Care in the United States? Comparison of Outcomes of Esophagectomy Between England and the United States

Outcomes of esophagectomy, including in-hospital mortality and length of stay (LOS), were compared between England (centralized care) and the US (no centralized care).  Data for 2005-2010 included 7433 esophagectomies performed in 66 hospitals in England and 5858 esophagectomies performed in 775 hospitals in the US.  Morality was greater in the US (5.5% vs 4.2%; p=0.001).  Predictors of mortality included age, comorbidities, hospital volume, and surgery in the US.  Interestingly, in high volume hospitals mortality was lower in the US (2.1% vs 3.5%; p=0.02).  LOS overall was greater in England; LOS decreased with increasing hospital volume in the US but not in England.