Association of hospital ownership status with outcomes after major gastrointestinal surgery

For-profit (FP) hospital ownership in the United States has increased. Although hospital financial structures may influence quality of care, the impact of FP ownership on outcomes after gastrointestinal (GI) surgery remains unclear. We sought to assess the association among FP hospital ownership, postoperative outcomes, and expenditures among patients undergoing 5 major GI surgical procedures.

Using the 2016-2019 National Inpatient Sample, adults undergoing esophagectomy, hepatectomy, pancreatectomy, colectomy, and proctectomy were identified. Multivariable regression was used to assess the association between FP hospital ownership and 30-day complications, in-hospital mortality, length of stay, discharge disposition, and inflation-adjusted costs. Analyses were stratified by surgical urgency (ie, elective and emergent) and procedural complexity (ie, complicated, intermediate, and uncomplicated).

Among 312,554 patients, 11.8% (n = 36,801) underwent surgery at FP hospitals, which were disproportionately small (27.3% [n = 10,042] vs 15.5% [n = 42,787]) and urban nonteaching (38.7% [n = 14,237] vs 16.9% [n = 46,777]) (both P <.001). FP ownership was associated with higher odds of 30-day complications (adjusted odds ratio [aOR], 1.12; 95% CI, 1.09-1.15) and nonhome discharge (aOR, 1.16; 95% CI, 1.12-1.20). Among elective procedures, FP hospitals had a higher risk of major complications (aOR, 1.28; 95% CI, 1.22-1.35), in-hospital mortality (aOR, 1.26; 95% CI, 1.06-1.49), and nonhome discharge (aOR, 1.34; 95% CI, 1.26-1.43); differences were attenuated in emergent cases. FP ownership was consistently associated with greater complications and nonhome discharge across procedural complexities, particularly among complicated surgeries (complications: aOR, 1.29; 95% CI, 1.14-1.47; discharge: aOR, 1.57; 95% CI, 1.34-1.84). However, total costs were lower at FP hospitals, notably among uncomplicated procedures (beta coefficient = -$3513; 95% CI, -$4003 to -$3022).

FP hospital ownership was independently associated with higher complication rates and mortality but lower costs after major GI surgery. Policies balancing cost-efficiency and surgical care quality warrant consideration.