• Oriana Ellis, Derek Kirby, Bethany Williamson, Julia Bader, Daniel Nelson, and Christopher Porta.
• General Surgery, William Beaumont Army Medical Center, El Paso, TX 79918, USA.
• Mil Med. 2023 Jul 22; 188 (7-8): e1821e1827e1821-e1827.

IntroductionSignificant controversy surrounds the "Take the Volume Pledge" campaign and the use of volume as a surrogate for quality. However, data on patient-reported attitudes toward this initiative are limited. We sought to examine patient preferences and perceptions regarding the location of their health care and the factors that may influence that decision.Materials And MethodsAfter IRB approval, we conducted a prospective study at a 109-bed tertiary referral military hospital, which performs 8 of the 10 defined high-risk low-volume surgeries. From 2018 to 2019, patients from all specialties completed anonymous questionnaires during preoperative registration. Univariate and multivariable analyses were performed to identify factors associated with patients desiring referral. Additional investigations into patient risk tolerance and thresholds regarding hospital/surgeon volume, postoperative complication risk, and cancer survival were analyzed.ResultsSix hundred and three surveys were completed and available for analysis. Only 1.5% expressed a desire to seek care from a high-volume subspecialist. On multivariable analysis, the only independent predictors for patients desiring referral were perceived displeasure with their care (P = .02) and not being asked their opinion on where to have surgery (P = .04). Most patients (57.6%) expressed willingness to stay at their home institution even if only half of the recommended volume of surgeries are performed. Of patients, 49.8% would accept a 10% increased risk of postoperative complications, and 55.3% would accept decreased long-term cancer survival to stay at their home institution.ConclusionsOnly 1.5% of our population desired referral to a high-volume center. Our study showed that an open discussion and shared decision-making are the most important factors for patients when deciding where to have surgery. Moreover, most were willing to accept greater risk and lower volume to stay at their local hospital. Although performed at a single military facility, this study showed that patient preferences are extremely important and should not be understudied.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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