EP574 - Colectomy Outcomes by Hospital Ownership Status: Do Patients Get Equal Care at For-Profit Institutions?

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Purpose/Background: Recent trends in health system mergers and conversion of non-profit to for-profit hospitals in the era of value-based care have renewed interest in evaluating surgical care and quality differences by ownership status. We aimed to assess differences in clinical and economic outcomes of patients undergoing colectomy in for-profit (FP) versus non-profit (NP) hospitals across the United States to establish differences in current colorectal surgical quality.

Methods/Interventions: We performed a retrospective observational study of patients undergoing elective right colectomy, 2016-2021, within the Healthcare Cost and Utilization Project Database (SID and SASD) across six states (FL, IA, MD, UT, VT, WI) at FP and NP non-federal acute care hospitals. The study focused on right colectomy because it is performed by surgeons of different training backgrounds, in inpatient and outpatient settings, and is the most common type of colectomy in the United States. Hospital ownership status and inflation-adjusted (USD, 2021) hospital-specific cost-to-charge ratios were abstracted from the American Hospital Association database. Multivariate regression was used to compare risk-adjusted differences in length of stay (LOS), routine discharge (home or self-care), cost of index admission, and 30-day readmission. Subgroup analysis was performed by short-stay (LOS≤1 day) or standard stay (LOS≥4 days).

Results/Outcomes: A total of 42,965 patients were included in the analysis with 7,103 (16.5%) receiving care at FP hospitals. 54.2% of patients were female, 10.4% were Black, 59.4% had Medicare, and 39.7% had 3 or more comorbidities (Table 1). 52% of colectomies were performed laparoscopically. Most patients received care at non-teaching hospitals (FP 99.1% vs. NP 79.8%, p< 0.001), with significantly fewer FP patients being treated at American College of Surgeon designated cancer centers (FP 48% vs. NP 75.3%, p< 0.001). Risk-adjusted outcomes showed significantly increased length of stay (+0.33 days; 95% CI 0.18-0.49 days), lower odds of routine discharge (OR 0.86; 95% CI 0.80-0.92), lower index admission cost (-$1097; 95% CI -$1672- -$522 ), and higher odds of 30-day readmission rate (OR 1.15; 95% CI 1.06-1.25) at FP relative to NP hospitals. In the short stay group, (n=2,087) there was a decreased odds of 30-day readmission (OR 0.54, 95% CI 0.31-0.91) at FP hospitals while the other outcomes remained similar. In the standard stay group (n=25,528), risk-adjusted outcomes showed lower odds of routine discharge (0.90 OR; 95% CI 0.83-0.98), lower index admission cost (-$1769; 95% CI -2,668- -871), and higher odds of 30-day readmission (OR 1.13; 95% CI 1.03-1.24) at FP hospitals.

Conclusion/Discussion: Despite historically mixed results regarding quality differences amongst FP versus NP hospitals, we show a greater LOS, lower odds of routine discharge, lower index admission cost, and increased readmission rates for patients undergoing right colectomy at FP versus NP hospitals. Decreased readmission risk for risk-adjusted short-stay patients suggests more similar care for outpatient colectomies.