在私募股权收购的医院进行肺切除术后的结果。

Postoperative outcomes following lung resection performed at private equity-acquired hospitals.

作者信息

Williams Jonathan E, Schaefer Sara L, Jacobs Ryan C, Jacobson-Davies Faelan, Ibrahim Andrew M, Odell David D

机构信息

Department of Surgery, University of Michigan, Ann Arbor, Mich; Center for Healthcare Outcomes and Policy, Institute for Healthcare and Policy Innovation, University of Michigan, Ann Arbor, Mich.

出版信息

J Thorac Cardiovasc Surg. 2025 Jun;169(6):1585-1592. doi: 10.1016/j.jtcvs.2024.12.032. Epub 2025 Jan 15.

DOI:10.1016/j.jtcvs.2024.12.032

PMID:39824345

Abstract

OBJECTIVE

Private equity acquisition of hospitals performing complex operations is increasingly prevalent in the US healthcare landscape. Although comparative health outcomes for common medical conditions have been investigated, the quality of thoracic surgical care in private equity-acquired hospitals is unknown.

METHODS

Medicare beneficiaries, aged 65 to 99 years, undergoing elective lung resection between 2016 and 2020 were included. Private equity-acquired hospitals were identified using the Agency for Healthcare Research and Quality Health System Compendium. Postoperative outcomes, including 30-day mortality, complications, failure to rescue, readmission, and postoperative length of stay were risk adjusted and compared with nonacquired hospitals using logistic regression considering patient age, sex, comorbidities, procedure type, and year of procedure.

RESULTS

Of 144,223 beneficiaries undergoing lung resection, 11,140 (7.7%) received care at private equity-acquired hospitals. Private equity-acquired hospitals performed fewer lung resections annually (mean = 4.2) than nonacquired hospitals (mean = 10.5; P < .001). Compared with nonacquired hospitals, patients treated at private equity-acquired hospitals demonstrated higher rates of 30-day mortality (2.1% vs 1.9%, odds ratio [OR], 1.17 [1.03-1.33]; P = .019), serious complications (8.1% vs 6.8%, OR, 1.29 [1.19-1.39]; P < .001), 30-day readmission (10.6% vs 9.9%, OR, 1.08 [1.01-1.15]; P = .028), and longer postoperative length of stay (5.9 vs 5.3 days; P < .001). Failure-to-rescue rates were not significantly different (9.8% vs 9.4%, OR, 1.05 [0.90-1.23]; P = .518).

CONCLUSIONS

These findings raise concern that private equity-acquired hospitals may provide lower-quality care for patients undergoing common thoracic procedures. Underlying structural factors may contribute to these differences. This motivates further investigation of specialty surgical care performed at private equity-acquired health institutions.

摘要

目的

在美国医疗保健领域，私募股权收购开展复杂手术的医院日益普遍。尽管已对常见疾病的相对健康结果进行了调查，但私募股权收购医院的胸外科护理质量尚不清楚。

方法

纳入2016年至2020年间接受择期肺切除术的65至99岁医疗保险受益人。使用医疗保健研究与质量机构的卫生系统纲要确定私募股权收购的医院。对术后结果，包括30天死亡率、并发症、抢救失败、再入院和术后住院时间进行风险调整，并使用逻辑回归，考虑患者年龄、性别、合并症、手术类型和手术年份，与未被收购的医院进行比较。

结果

在144,223名接受肺切除术的受益人中，11,140名（7.7%）在私募股权收购的医院接受治疗。私募股权收购的医院每年进行的肺切除术（平均 = 4.2例）少于未被收购的医院（平均 = 10.5例；P < .001）。与未被收购的医院相比，在私募股权收购的医院接受治疗的患者30天死亡率更高（2.1%对1.9%，优势比[OR]，1.17[1.03 - 1.33]；P = .019），严重并发症发生率更高（8.1%对6.8%，OR，1.29[1.19 - 1.39]；P < .001），30天再入院率更高（10.6%对9.9%，OR，1.08[1.01 - 1.15]；P = .028），术后住院时间更长（5.9天对5.3天；P < .001）。抢救失败率无显著差异（9.8%对9.4%，OR , 1.05[0.90 - 1.23]；P = .518）。