Ownership Matters: The Association Between Hospital Ownership and Older Adult Patient Outcomes in Emergency General...

Hospital ownership has been associated with variations in care quality and patient outcomes. This study aimed to examine the association between hospital ownership and outcomes among older adults undergoing emergency general surgery (EGS).

We utilized the 2019 Nationwide Readmissions Database to identify EGS patients of ≥65 y of age. Hospitals were stratified into nonfederal government, private not-for-profit (PNFP), and private for-profit (PFP). Multivariable logistic regression adjusting for patient demographics, comorbidities, disease severity, and hospital characteristics (e.g., teaching status, region) was used to evaluate the association between hospital ownership and patient inhospital mortality and postoperative complications.

A total of 95,236 patients were included: 8499 (9%) in government, 72,219 (76%) in PNFP, and 14,518 (15%) in PFP hospitals. On univariate analysis, patients treated at government hospitals had the highest mortality (4.0% versus 3.2% versus 2.7%, P < 0.001). On multivariable analyses, patients at both PNFP and PFP hospitals had lower mortality (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.73-0.95; aOR 0.71, 95% CI 0.60-0.84, respectively) and hospital length of stay (aOR 0.91, 95% CI 0.86-0.96; aOR 0.88, 95% CI 0.82-0.95, respectively) compared to government hospitals. Patients treated at PNFP hospitals had a lower risk of developing infectious complications (aOR 0.89, 95% CI 0.81-0.98). However, those at PFP hospitals had an increased risk of composite complications (aOR 1.26, 95% CI 1.17-1.36), including infectious, cardiorespiratory, and renal complications.

While private hospitals demonstrated lower mortality and shorter length of stay compared to government hospitals, for-profit institutions were associated with higher rates of postoperative complications. These findings underscore the need to examine structural and systemic factors within hospital types that may influence quality of care and patient outcomes among older adults undergoing EGS procedures.