Impact of Private Equity Acquisition of Hospitals on Surgical Outcomes.

OBJECTIVE

To characterize outcomes of patients undergoing a major surgical procedure at private equity-acquired (PEA) versus non-acquired centers.

BACKGROUND

Private-equity acquisitions of health centers can be followed by policy changes aimed at maximizing profit over quality of care.

METHODS

Patients who underwent a major surgical procedure between 2016 and 2021 were identified using 100% Medicare Standard Analytic Files. Propensity score matching (PSM) created a well-balanced 1:1 matched cohort among patients treated at PEA and non-PEA hospitals; multivariable regression was used to assess outcomes, including complications, failure-to-rescue (FTR), extended length of inpatient stay (LOS), 90-day readmission, and 90-day mortality.

RESULTS

1,124,877 patients (coronary artery bypass graft: n=310,455, 27.6%, abdominal aortic aneurysm repair: n=278,739, 24.8%, pneumonectomy: n=97,103, 8.6%, pancreatectomy: n=23,712, 2.1%, colectomy: n=414,868, 36.9%) were included; 11.9% (n=134,168) of patients underwent surgery at PEA centers. PEA centers were more likely to be low-volume (54.0% vs 29.3%) and nonteaching (52.0% vs 29.6%) hospitals (both P <0.001). PEA versus non-acquired centers more often treated patients from socially vulnerable communities (45.5% vs 31.4%) for nonmalignant conditions (77.5% vs 74.6%) (both P <0.001). After PSM, treatment at PEA remained associated with higher odds of extended LOS [odds ratio (OR): 1.09%, 95% CI: 1.07-1.11), complications (OR: 1.13, 95% CI: 1.10-1.16), FTR (OR: 1.07, 95% CI: 1.01-1.14), 90-day readmission (OR: 1.13, 95% CI: 1.11-1.15), and 90-day mortality (OR: 1.17, 95% CI: 1.14-1.20).

CONCLUSIONS

Major surgical procedures at PEA centers were associated with relatively worse patient outcomes. Private equity acquisition of hospital centers needs to be carefully scrutinized to ensure that care quality is prioritized over financial returns.