The association between hospital ownership and postoperative complications: Does it matter who owns the hospital?

Atala, Robby; Kroth, Philip J

doi:10.1177/1460458219899827

Cited by 3 publications

(1 citation statement)

References 19 publications

(26 reference statements)

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“…Although some studies have demonstrated that these hospitals have improved postoperative outcomes and decreased mortality following other major surgeries, other studies have shown that larger hospitals may be associated with increased risk of complications in certain surgical disciplines. [19][20][21][22] We postulate that the demographic and socioeconomic characteristics associated with elevated risk for potential complications following surgery likely contribute to the worse than expected outcomes following ESS in the NIS.…”

Section: Discussionmentioning

confidence: 99%

Inpatient Sinus Surgery Patient Morbidity and Outcomes: A National Analysis

et al. 2021

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Objectives/Hypothesis: To investigate the morbidity and mortality of patients undergoing endoscopic sinus surgery (ESS) in the inpatient setting.Study Design: Retrospective database review. Methods: The Nationwide Inpatient Sample was queried for all ESS between 2008 and 2014. Using All Patients Refined Diagnosis Related Groups (APR-DRG) codes, cases with APR-DRG codes under Major Diagnostic Category 3 (Diseases and Disorders of the Ear, Nose, Mouth, and Throat) were designated as patients with primary otolaryngology diagnoses undergoing ESS (ORL), and all other codes were designated as patients with non-otolaryngology pathologies as their primary reason for admission but undergoing ESS (non-ORL). A univariate analysis and a logistic regression were used to compare patient demographics, comorbidities, disease severity, and mortality.Results: There were 8,305 ORL patients and 6,342 non-ORL patients. ORL patients were more likely to be elective admissions (61.3% vs. 48.5%, P < .001), have a deviated nasal septum (17.9% vs. 12.3%, P < .001), nasal polyps (15.8% vs. 5.0%, P < .001), obstructive sleep apnea (10.7% vs. 5.2%, P < .001), and pulmonary disease (15.9% vs. 10.5%, P < .001). Non-ORL patients had a higher likelihood of in-hospital mortality (odds ratio [OR] 6.22, 95% confidence interval [CI] 3.29-11.78, P < .001), length of stay in the highest quartile (OR 2.43, 95% CI 2.16-2.74, P < .001), and a higher proportion had APR-DRG subclasses indicating extreme severity of illness (19.3% vs. 4.3%, P < .001) or extreme risk of mortality (12.5% vs. 2.0%, P < .001).Conclusion: Patients undergoing ESS in the inpatient setting have a higher than expected mortality rate which can be associated with a non-otolaryngology pathology as the primary reason for their admission.

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Section: Discussionmentioning

confidence: 99%

Inpatient Sinus Surgery Patient Morbidity and Outcomes: A National Analysis

et al. 2021

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Outcomes related to hospital characteristics of heart transplant centers: A National Readmission Database analysis

Amirkhosravi,

Nguyen,

Del Rio

et al. 2024

JHLT Open

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Association between hospital ownership and patient selection, management, and outcomes after carotid endarterectomy or carotid artery stenting

Kuehnl,

Kallmayer,

Bohmann

et al. 2024

BMC Surg

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Background This study analyses the association between hospital ownership and patient selection, treatment, and outcome of carotid endarterectomy (CEA) or carotid artery stenting (CAS). Methods The analysis is based on the Bavarian subset of the nationwide German statutory quality assurance database. All patients receiving CEA or CAS for carotid artery stenosis between 2014 and 2018 were included. Hospitals were subdivided into four groups: university hospitals, public hospitals, hospitals owned by charitable organizations, and private hospitals. The primary outcome was any stroke or death until discharge from hospital. Research was funded by Germany’s Federal Joint Committee Innovation Fund (01VSF19016 ISAR-IQ). Results In total, 22,446 patients were included. The majority of patients were treated in public hospitals (62%), followed by private hospitals (17%), university hospitals (16%), and hospitals under charitable ownership (6%). Two thirds of patients were male (68%), and the median age was 72 years. CAS was most often applied in university hospitals (25%) and most rarely used in private hospitals (9%). Compared to university hospitals, patients in private hospitals were more likely asymptomatic (65% vs. 49%). In asymptomatic patients, the risk of stroke or death was 1.3% in university hospitals, 1.5% in public hospitals, 1.0% in hospitals of charitable owners, and 1.2% in private hospitals. In symptomatic patients, these figures were 3.0%, 2.5%, 3.4%, and 1.2% respectively. Univariate analysis revealed no statistically significant differences between hospital groups. In the multivariable analysis, compared to university hospitals, the odds ratio of stroke or death in asymptomatic patients treated by CEA was significantly lower in charitable hospitals (OR 0.19 [95%-CI 0.07–0.56, p = 0.002]) and private hospitals (OR 0.47 [95%-CI 0.23–0.98, p = 0.043]). In symptomatic patients (elective treatment, CEA), patients treated in private or public hospitals showed a significantly lower odds ratio compared to university hospitals (0.36 [95%-CI 0.17–0.72, p = 0.004] and 0.65 [95%-CI 0.42-1.00, p = 0.048], respectively). Conclusions Hospital ownership was related to patient selection and treatment, but not generally to outcomes. The lower risk of stroke or death in the subgroup of electively treated patients in private hospitals might be due to the right timing, the choice of treatment modality or actually to better structural and process quality.

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The association between hospital ownership and postoperative complications: Does it matter who owns the hospital?

Cited by 3 publications

References 19 publications

Inpatient Sinus Surgery Patient Morbidity and Outcomes: A National Analysis

Inpatient Sinus Surgery Patient Morbidity and Outcomes: A National Analysis

Outcomes related to hospital characteristics of heart transplant centers: A National Readmission Database analysis

Association between hospital ownership and patient selection, management, and outcomes after carotid endarterectomy or carotid artery stenting

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