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Increased market competition is associated with lower mortality after complex aortic surgery
Zach M Feldman1, Gregory Leya2, Andrew Oseran3
1Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Journal of Vascular Surgery
|April 30, 2025
Summary
Higher competition in local markets is linked to better short-term survival for complex aortic surgery patients. However, long-term survival remains similar across different market competition levels. Further research is needed to understand and improve care access.
Area of Science:
- Vascular Surgery
- Health Services Research
- Surgical Outcomes
Background:
- Centralized aortic centers in competitive markets may have worse outcomes.
- Local market competition's impact on complex aortic surgery is not well understood.
Purpose of the Study:
- To evaluate how local market competition affects outcomes of complex aortic surgery.
- To analyze the association between market competition and 30-day mortality and long-term survival.
Main Methods:
- Retrospective review of 10,868 patients from the Vascular Quality Initiative (VQI) (2013-2022).
- Market competition defined by Herfindahl-Hirschman Index (HHI); higher HHI indicates lower competition.
- Multivariable logistic and Cox survival models used; sensitivity analysis included the Vascular Implant Surveillance and Interventional Outcomes Network (VIISON).
Main Results:
- Lower 30-day mortality observed in high competition regions (23.7%) compared to medium (25.9%) and low (25.9%) competition.
- Medium regional competition was associated with increased 30-day mortality odds (OR, 1.39) versus high competition.
- Sensitivity analyses showed similar trends, but no significant difference in long-term mortality was found across competition levels.
Conclusions:
- More competitive regions show lower 30-day mortality after complex aortic surgery.
- Long-term survival rates are equivalent regardless of market competition.
- Efforts should focus on understanding the drivers of improved short-term outcomes to enhance access to high-quality care.
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