Outcomes Following Colectomy at For-Profit Hospitals: A National Analysis.

Abstract

BackgroundOne of the most commonly performed operations in the US, colectomy remains associated with a substantial incidence of postoperative complications. While there is increasing recognition that hospital for-profit financial structure may be linked with variation in morbidity, the impact of care at for-profit (FP) hospitals on outcomes following colectomy remains to be elucidated.MethodsAll adults undergoing elective/emergent colectomy for diverticular disease, inflammatory bowel disease, benign colonic neoplasms, or colon cancer, ≤2days of admission, were tabulated from the Nationwide Readmissions Database. Patients were stratified by care at FP centers into the FP and Non-FP cohorts. Following entropy balancing, multivariable models were developed to consider the independent association of FP status with key outcomes.ResultsOf ∼1,130,803 admissions for colectomy, 862 495 (76.3%) were elective. Among electively admitted patients, 74 933 (8.7%) were grouped as FP. After risk adjustment, care at FP institutions was associated with greater odds of major morbidity (AOR 1.27, CI 1.22-1.32), non-home discharge (AOR 1.20, CI 1.13-1.27), and non-elective readmission (AOR 1.26, CI 1.12-1.32), but lower per-patient expenditures (β-$2430/patient, CI -2,860, -2010). Considering the 268 308 emergent cases, 38 568 (14.4%) were managed at FP hospitals. Following multivariable adjustment, treatment at FP hospitals remained associated with increased morbidity (AOR 1.16, CI 1.11-1.21) and decreased costs (β-$5,630, CI -6,210, -5,050).DiscussionUndergoing colectomy at FP hospitals was associated with greater complications and readmissions, but reduced per-patient expenditures. Future research should consider the factors contributing to inferior clinical outcomes at these centers. Best practices should be shared across institutions, irrespective of financial structure.