• Mujtaba Khalil, Zayed Rashid, Selamawit Woldesenbet, Abdullah Altaf, Jun Kawashima, Odysseas P Chatzipanagiotou, Susan Tsai, and Timothy M Pawlik.
• Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
• J. Am. Coll. Surg. 2025 Jan 13.

IntroductionWe aimed to investigate the geographic variation of Academic Medical Centers (AMCs) across different healthcare markets and the impact on surgical outcomes in nearby non-AMCs.MethodsPatients who underwent major surgery between 2016 and 2021 were identified from the Medicare Standard Analytic Files. Healthcare markets were delineated using Dartmouth Atlas hospital referral regions. Multivariable regression was used to examine the association between the presence of market-level AMCs and surgical outcomes in neighboring non-AMCs.ResultsA total of 388,431 Medicare beneficiaries underwent major surgery (CABG: n=97,346, 25.1%; AAA repair: n=67,000, 17.3%; pneumonectomy: n=30,500, 7.9%; pancreatectomy: n=5,341, 1.4%; colectomy: n=188,244, 48.5%) at 2,757 non-AMCs. Median age was 74 years (IQR: 70-80), and roughly one-half of patients was male (n=215,569, 55.5%). Notably, 43.1% of individuals underwent surgery in markets with low AMC presence, 48.0% in markets with moderate AMC presence, and 8.9% in markets with high AMC presence. On multivariable analysis, compared with low AMC markets, high AMC presence was associated with decreased risk of extended length-of-stay (-1.51%, 95% CI -2.03 to -1.00), postoperative complications (-1.20%, 95% CI -1.76 to -0.65), 90-day readmission (-2.39%, 95% CI -2.90 to -1.88), and mortality (-0.64% 95% CI -0.98 to -0.30) (all p<0.001). Moreover, high AMC market presence was associated with a 2.93% (-2.93%, 95% CI -3.17 to -2.68; p<0.001) decrease in expenditures for the index surgical procedure.ConclusionHigh market presence of AMCs was associated with lower morbidity and mortality rates at nearby non-AMCs. The influence of AMCs on clinical outcomes likely extends beyond direct patient care, indicating spillover effects of AMCs on outcomes for patients in neighboring non-AMCs.Copyright © 2025 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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