Distance-only models fail to accurately predict where patients receive pancreaticoduodenectomy (PD).

• Accuracy: distance-only model (16.3%), distance + volume model (32.9%), comprehensive model (24.3%).
• Patients correctly predicted by volume models were more often from urban areas (74.7% vs. 61.0%) and had lower in-hospital mortality (1.3% vs. 3.3%).

Surgeons need to consider additional factors beyond distance, like hospital volume and patient demographics, to optimize outcomes and patient selection.