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

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.

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.

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).

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.