Regionalizing high-risk surgery by restricting care to high-volume centers of excellence is a
qualityimprovement strategy with intuitive appeal. Decades of research have shown that the
highest-volume hospitals have better outcomes for major surgery. 1 Accordingly, 3
prominent medical centers—Dartmouth-Hitchcock Medical Center, Johns Hopkins Medicine,
and the University of Michigan—recently announced a “volume pledge” to restrict their own
facilities and surgeons from performing any of 10 selected procedures unless they meet …