Original article
Adult cardiac
Effect of Hospital Ownership on Outcomes After Left Ventricular Assist Device Implantation in the United States

https://doi.org/10.1016/j.athoracsur.2018.08.051Get rights and content

Background

We evaluated the effects of hospital ownership, classified into three tiers (nonfederal government, not-for-profit, and for-profit hospitals), on in-hospital outcomes after implantation of continuous-flow left ventricular assist devices (LVADs) in the United States from 2009 to 2014.

Methods

Data from the National Inpatient Sample were used to calculate annual national estimates in utilization, in-hospital mortality, major complications, lengths of stay, cost of hospitalization, and disposition at discharge for years 2009 to 2014. Complications were calculated using patient safety indicators and International Classification of Diseases, Ninth Revision, Clinical Modification codes.

Results

Of the 3,571 patients (weighted, 17,547) with LVAD implants in the United States between 2009 and 2014, 82.1% were in not-for-profit hospitals, 15.6% in nonfederal government hospitals, and 2.3% in for-profit hospitals. In-hospital mortality significantly decreased over time only in not-for-profit hospitals by average annual change of –7.4% (p = 0.001) and was higher in for-profit hospitals than other tiers of hospital ownership. Our analysis did not suggest any differences in postoperative complications among different hospital ownership types. LVAD implantation in nonfederal government hospitals was associated with the highest cost ($227,930; interquartile range [IQR], $173,259 to $301,566) and implantation in for-profit hospitals was associated with lower cost ($148,406; IQR, $133,149 to $199,317; p = 0.03). The length of stay was similar across the three tiers of hospital ownership. Nonroutine discharge was significantly more frequent in not-for-profit hospitals (73.6%; IQR 69.5% to 77.7%) compared with nonfederal government (48.8%; IQR, 42.4% to 55.1%) and for-profit (59.8%; IQR, 43.0% to 76.6%) hospitals (p < 0.001).

Conclusions

Disparities in in-hospital mortality, cost, and disposition exist between various hospital ownerships during admission for LVAD implant.

Section snippets

Data Source

The source of data was the National Inpatient Sample (NIS) of the Healthcare Utilization Project (HCUP), sponsored by the Agency for Healthcare Research and Quality, a large all-payer database of hospital inpatient stays in the Unites States (US). The details and description of the design of the sample has been previously described and its available online [12]. Discharge data set from a 20% stratified sample of US hospitals are recorded in the NIS, which is a part of the HCUP [12]. In a

Patient Characteristics

The main baseline patient-and hospital-level characteristics are presented in Table 1. We identified 3,571 LVAD implants (weighted, 17,547) between 2009 and 2014. The implant in 82.1% of patients occurred in not-for-profit hospitals, 15.6% in nonfederal government hospitals, and 2.3% in for-profit hospitals (Table 1). Patients who underwent the implant in for-profit hospitals were significantly older than those whose implant occurred in nonfederal government and not-for-profit hospitals. We did

Comment

In our current study, we determined that outcomes differed based on the type of hospital ownership among the LVAD implants performed from 2009 to 2014 using a nationally representative sample. Specifically, we found increased in-hospital mortality after LVAD implantation among for-profit hospitals, significantly higher rates of nonroutine discharge and discharge to extended-care facility among not-for-profit hospitals, and higher median cost of hospitalization in nonfederal government hospitals.

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© 2019 by The Society of Thoracic Surgeons Published by Elsevier