Esophagectomy Trends and Postoperative Outcomes at Private Equity–Acquired Health Centers

Importance: Growing trends in private equity acquisition of acute care hospitals in the US have motivated investigations into quality of care delivered at these health centers. While some studies have explored comparative outcomes for high-acuity medical conditions, care trends and outcomes of complex surgical procedures, such as esophagectomy, at private equity-acquired hospitals is unknown. Objective: To compare structural characteristics and postoperative outcomes following esophagectomy between private equity-acquired and nonacquired health centers. Design, Setting, and Participants: This retrospective cohort study included Medicare beneficiaries aged 65 to 99 years who underwent elective esophagectomy at US health centers between January 1, 2016, and December 31, 2020. Health centers were designated as private equity acquired using the Agency for Healthcare Research and Quality Compendium of US Health Systems. Data were analyzed between October 15, 2023, and March 30, 2024. Exposure: Patient cohorts were created based on whether they received care at private equity-acquired or nonacquired health centers. Main Outcomes and Measures: The main outcome was 30-day postoperative complications, mortality, failure to rescue, and readmission using summary statistics and multivariable logistic regression. Results: A total of 9462 patients (mean [SD] age, 72.9 [5.6] years; 6970 male [73.7%]) underwent esophagectomy during the study period, with 517 (5.5%) receiving care at private equity-acquired institutions. Annual procedure volume was lower at private equity-acquired hospitals vs nonacquired hospitals (median, 2 [IQR, 1-4] vs 7 [IQR, 3-15] procedures per year). Compared with patients treated at nonacquired hospitals, patients treated at private equity-acquired hospitals had significantly higher 30-day mortality (8.1% [95% CI, 5.8%-10.3%] vs 4.9% [95% CI, 4.5%-5.3%]; odds ratio [OR], 1.82 [95% CI, 1.25-2.64]; P = .002), any complications (36.6% [95% CI, 32.9%-40.3%] vs 30.1% [95% CI, 29.2%-30.9%]; OR, 1.46 [95% CI, 1.18-1.80]), serious complications (17.5% [95% CI, 14.5%-20.6%] vs 14.3% [95% CI, 13.7%-15.0%]; OR, 1.34 [95% CI, 1.03-1.77]; P = .03), and failure to rescue (5.9% [95% CI, 3.9%-7.9%] vs 3.4% [95% CI, 3.1%-3.8%]; OR, 1.86 [95% CI, 1.22-2.84]; P = .004). Conclusions and Relevance: These findings suggest that patients who undergo esophagectomy at private equity-acquired hospitals may be at risk for worse outcomes. Further understanding of the drivers of these outcomes is needed to improve performance and inform policy pertaining to care allocation for select surgical conditions.