Private Equity Hospitals Have Worse Esophagectomy Outcomes

TOPLINE:

Patients undergoing esophagectomy at private equity–acquired health centers have an increased risk for mortality, surgical complications, and failure to rescue than those undergoing the procedure at nonacquired health centers.

METHODOLOGY:

• The increasing acquisition of health systems by private equity in the United States raises concerns about healthcare quality and costs, particularly in the context of esophagectomy, a complex surgical procedure that demands substantial resources and expertise.
• A retrospective cohort study compared postoperative outcomes between private equity–acquired (identified using the Agency for Healthcare Research and Quality’s Compendium of US Health Systems) and nonacquired health centers among Medicare beneficiaries aged 65-99 years who underwent esophagectomy between October 2023 and March 2024.
• Postoperative outcomes included the 30-day mortality rate, occurrence of any complication and serious complications, failure to rescue, and 30-day readmission rate.
• A sensitivity analysis was performed to compare similarly low-volume private equity–acquired and nonacquired hospitals and included 2878 patients, of whom 337 underwent resection at private equity–acquired health centers.

TAKEAWAY:

• In total, 9462 patients (mean age, 72.9 years; 73.7% men; 89.6% White) underwent elective esophagectomy, with 5.5% (n = 517) treated at private equity–acquired health centers.
• Private equity–acquired health centers vs nonacquired health centers demonstrated a decreased annual esophagectomy case volume (median, 2 vs 7 procedures per year; P P
• Compared with patients who underwent esophagectomy at nonacquired health centers, those receiving this treatment at private equity–acquired health centers had:
  • 82% higher odds of 30-day mortality (P = .002)
  • 46% higher odds of experiencing any complication (P = .001)
  • 35% higher odds for serious complications (P = .03)
  • 86% higher odds for failure to rescue (P = .004)
• Readmission rates were comparable between private equity–acquired and nonacquired health centers.
• The sensitivity analysis also favored patients treated at nonacquired health centers, with patients treated at private equity–acquired health centers showing higher odds of 30-day mortality (P = .003) and a greater likelihood of experiencing any complication (P = .03).

IN PRACTICE:

“[The study] findings suggest that poorer postoperative outcomes at private equity–acquired health centers may be attributed to characteristic structural differences associated with private equity acquisition,” the authors wrote.

“The message from this article is the necessity to keep an eye not only on esophagectomy outcomes but also on all complex surgical procedures among hospital types and to raise the alarm if needed. Either private equity–acquired hospitals need to invest in quality databases, hire more staff, and educate staff on perioperative care, or they need to recognize the private inequity they are providing for complex cases,” Aaron R. Dezube, MD, and Virginia R. Litle, MD, wrote in an invited commentary.

SOURCE:

The study, led by Jonathan E. Williams, MD, Department of Surgery, University of Michigan, Ann Arbor, was published online in JAMA Surgery.

LIMITATIONS:

The reliance on Medicare data limited generalizability to younger populations. The lack of clinical granularity due to the use of claims data may have affected the assessment of comorbidities and complications. The lack of temporal data on private equity acquisition limited the ability to assess changes over time. The data sources did not provide a comprehensive comparison of all institutional factors influencing patient care.

DISCLOSURES:

This study was supported by grants from the National Institutes of Health and National Cancer Institute. Some authors reported receiving grants during the conduct of the study, and one author reported receiving grants outside the submitted work. Two authors reported receiving personal fees from JAMA Network as visual abstract editors outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.