Association of hospital market competition with high-risk surgical procedure outcomes

Editor's Note

This study from the University of Michigan, Ann Arbor, examines the association between hospital market competition and outcomes after high-risk surgical procedures.

A total of 2,248,438 Medicare beneficiaries who had 1 of 10 high-risk surgical procedures between 2015 and 2018 were included in the analysis.

Compared with low-competition hospitals, high-competition hospitals demonstrated:

• higher 30-day mortality for 2 of 10 procedures—mitral valve repair and carotid endarterectomy
• no difference in 30-day mortality for 5 of 10 procedures—open aortic aneurysm repair, bariatric surgery, esophagectomy, knee replacement, and hip replacement
• higher 30-day readmissions for 5 of 10 procedures—open aortic aneurysm repair, knee replacement, mitral valve repair, rectal resection, and carotid endarterectomy
• no difference in 30-day readmissions for 3 of 10 procedures—bariatric surgery, esophagectomy, and pancreatectomy.

The results also showed that hospitals in high-competition markets cared for patients who were older, were more likely to be racial and ethnic minorities, and had more comorbidities.

The researchers concluded that there was no consistent association between degree of hospital market competition and outcomes after high-risk surgery, and that hospitals in high-competition markets cared for sicker patients. Efforts to address differences in surgical quality should investigate factors other than hospital competition, they say.