Association of hospital for-profit status with clinical and financial outcomes following emergency general surgery

Background

The impact of for-profit (FP) hospital ownership on healthcare outcomes has garnered increasing attention in recent years with limited work linking FP status with lower quality of care and higher costs. However, outcomes emergency general surgery (EGS) at FP hospitals remains unknown.

Methods

All non-elective adult (≥18 years) hospitalizations entailing EGS (appendectomy, cholecystectomy, laparotomy, large bowel resection, perforated ulcer repair, or small bowel resection), within 2 days of admission, were tabulated from the 2016 to 2021 National Inpatient Sample. Multivariable models were constructed to evaluate the independent associations between hospital FP status with key clinical and financial outcomes.

Results

Of an estimated 2,124,394 patients, 337,950 (16 %) were classified as FP. Compared to others, the FP cohort was younger, of lower comorbidity burden, and more frequently in the lowest income quartile. After risk adjustment, care at FP hospitals was associated with a greater likelihood of in-hospital mortality or any major complication (Adjusted Odds Ratio [AOR] 1.15, 95 % Confidence Interval [CI] 1.12–1.18), including infectious (AOR 1.22, 95 % CI 1.18–1.26), respiratory (AOR 1.26, 95 % CI 1.21–1.31), and renal sequelae (AOR 1.12, 95 % CI 1.08–1.16). While associated with reduced per-patient hospitalization costs (β -$2910, 95 % CI -3180,-2640), treatment at FP institutions was associated with increased odds of non-home discharge (AOR 1.09, 95 % CI 1.05–1.13).

Conclusions

Care at for-profit hospitals appears to be associated with greater risk of morbidity and nonhome discharge. Future work is needed to consider the factors contributing to greater morbidity, and developing interventions aimed at improving quality of care.