High-risk cancer surgeries, specifically for gastric and hepatopancreatobiliary (HPB) cancer, are complex major abdominal operations with significant known associated morbidity and mortality. 1 Schneider E.B. Hyder O. Wolfgang C.L. et al. Patient readmission and mortality after surgery for hepato-pancreato-biliary malignancies. Centralization, or the selective performance of high-risk operations by experienced surgeons at high-volume hospitals (HVH), is important to consider because it is based on the well-documented inverse relationship between both surgeon- and hospital-specific volume and operative and surgical mortality, respectively, for cancer operations. 2 Sheetz K.H. Dimick J.B. Nathan H. Centralization of high-risk cancer surgery within existing hospital systems. , 3 Birkmeyer J.D. Siewers A.E. Finlayson E.V. et al. Hospital volume and surgical mortality in the United States. , 4 Birkmeyer J.D. Stukel T.A. Siewers A.E. et al. Surgeon volume and operative mortality in the United States. However, centralization of care is associated with a significant travel burden for some patients and has worsened existing disparities related to treatment at high-volume vs low-volume centers. 5 Stitzenberg K.B. Sigurdson E.R. Egleston B.L. et al. Centralization of cancer surgery: implications for patient access to optimal care. If/when complication occurs after these high-risk operations, patients unable or unwilling to travel to the index hospital are admitted to an outside hospital (OSH), resulting in care fragmentation. Care fragmentation in patients after complex oncologic operation is an emerging issue associated with increased mortality. 6 Zheng C. Habermann E.B. Shara N.M. et al. Fragmentation of care after surgical discharge: non-index readmission after major cancer surgery.