The following is a summary of “Association between Hospital Ownership and Patient Selection, management, and Outcomes after Carotid Endarterectomy or Carotid Artery Stenting,” published in the May 2024 issue of Surgery by Kuehnl et al.
This study comprehensively examines the association between hospital ownership and its impact on patient selection, treatment strategies, and clinical outcomes following carotid endarterectomy (CEA) or carotid artery stenting (CAS).
The analysis draws from data within the Bavarian subset of Germany’s nationwide statutory quality assurance database, encompassing patients undergoing CEA or CAS for carotid artery stenosis between 2014 and 2018. Hospitals were categorized into four distinct ownership groups: university hospitals, public hospitals, charitable organization-owned hospitals, and private hospitals. The primary endpoint evaluated was the occurrence of any stroke or mortality up to discharge from the hospital. Germany’s Federal Joint Committee Innovation Fund (01VSF19016 ISAR-IQ) provided funding for this research.
A total of 22,446 patients were included in the study, with the majority treated in public hospitals (62%), followed by private hospitals (17%), university hospitals (16%), and charitable-owned hospitals (6%). The study population predominantly comprised male patients (68%), with a median age of 72. CAS procedures were most frequently performed in university hospitals (25%) and least commonly in private hospitals (9%).
Notably, asymptomatic patients were more prevalent in private hospitals compared to university hospitals (65% vs. 49%). Among asymptomatic patients, the incidence of stroke or mortality varied across hospital types: university hospitals (1.3%), public hospitals (1.5%), charitable-owned hospitals (1.0%), and private hospitals (1.2%). In patients with symptoms, these rates were 3.0%, 2.5%, 3.4%, and 1.2%, respectively. Univariate analysis did not reveal statistically significant differences between hospital groups. However, the multivariable analysis demonstrated significantly lower odds ratios for stroke or mortality in patients with asymptomatic undergoing CEA in charitable-owned hospitals (OR 0.19, 95%-CI 0.07–0.56, p = 0.002) and private hospitals (OR 0.47, 95%-CI 0.23–0.98, p = 0.043) compared to university hospitals. Similarly, for patients with symptoms were undergoing elective CEA, private hospitals showed a significantly lower odds ratio (OR 0.36, 95%-CI 0.17–0.72, p = 0.004) compared to university hospitals, with public hospitals also demonstrating a lower odds ratio (OR 0.65, 95%-CI 0.42–1.00, p = 0.048).
The findings suggest that hospital ownership influences patient selection and treatment strategies, yet overall clinical outcomes were not consistently associated with ownership type. Notably, the observed lower risk of stroke or mortality among electively treated patients in private hospitals may reflect optimized intervention timing, treatment modality choices, or superior structural and procedural quality. These insights underscore the complex interplay between hospital ownership and clinical outcomes in vascular surgical practice.
Source: bmcsurg.biomedcentral.com/articles/10.1186/s12893-024-02448-6
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