Influence of hospital ownership on patient outcomes in STEMI-induced cardiogenic shock undergoing revascularization: a retrospective cohort study
Authors: Sequeira Gross J , Malik M , Francis Morel G 
Published: October 2024

Abstract

Background
Investor-owned hospitals constitute an expanding segment of healthcare enterprises that frequently eschew the provision of non-profitable services. The implications of this disparity in costs on the mortality rates of patients experiencing cardiogenic shock (CS) subsequent to ST-Elevation Myocardial Infarction (STEMI) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) or bare-metal stents (BMS) remain unknown.

Methods
In this retrospective analysis, data from the National Inpatient Sample (NIS) were examined, including acute care admissions for patients aged 18 years and above admitted due to cardiogenic shock secondary to ST-Elevation Myocardial Infarction (STEMI) who underwent percutaneous coronary intervention (PCI) with the placement of either drug-eluting stents (DES) or bare-metal stents (BMS) between 2016 and 2020. Multivariable logistic regression, multilinear regression, chi-square tests, and t-tests were used to compare mortality rates, length of stay (LOS), and healthcare costs, adjusting for potential confounders. The total charges were adjusted for inflation using the Consumer Price Index (CPI) from the Bureau of Labor Statistics to ensure consistency in financial evaluations.

Results
We analyzed 66,180 patients and divided them into two cohorts: admitted to investor-owned vs nonprofit institutions. The findings revealed no significant difference in mortality rates, with an adjusted odds ratio (aOR) of 1.03 (P=0.60; 95% CI: 0.91-1.16). However, treatment in investor-owned hospitals was associated with significantly higher healthcare costs, with a coefficient of 120,921 (P&lt;0.001; 95% CI: 106,658.6–135,184.7), but without a significant difference in length of stay (LOS) (coefficient 0.04; P=0.81; 95% CI: -0.33 to 0.41). Key predictors of mortality included age, with each additional year increasing the odds of mortality by 3% (P&lt;0.001; 95% CI: 1.02-1.03), and uninsured status, which was linked to a higher mortality risk (aOR 1.40; P&lt;0.001; 95% CI: 1.16-1.70). Disparities in healthcare costs were observed across different races and insurance types, notably affecting Hispanic patients and those covered by Medicaid. A significant difference was noted in the average adjusted hospital charges between non-profit and investor-owned hospitals; the average charge at investor-owned hospitals was $314,633, compared to $220,227 at non-profit hospitals (P&lt;0.01), marking a net difference of $94,406.

Conclusion
This retrospective cohort analysis demonstrated that investor-owned hospitals incurred, on average, over $94,406 more in healthcare costs than nonprofit hospitals, with no significant difference in mortality rates and only a marginal difference in length of stay (LOS). Higher expenses at investor-owned hospitals did not translate into improved patient outcomes, challenging the notion that increased healthcare spending necessarily results in better healthcare delivery.