Patients with common cancers treated at centralized hub hospitals are more likely to receive evidence-aligned care compared to those treated at spoke hospitals within decentralized health systems.

• 70.9% adherence to evidence-aligned surgical care was observed overall, but this varied significantly between highly adopted (77.4%) and poorly adopted practices (29.9%).
• For poorly adopted practices, hubs in centralized systems showed superior adherence to evidence-based care versus spoke locations, with an odds ratio of 0.804.

Surgeons should consider how the structure of their health systems influences the quality of care patients receive, particularly for less frequently adopted practices.