Influence of Hospital Ownership on Patient Outcomes in ST-Elevation Myocardial Infarction-Induced Cardiogenic Shock Undergoing Revascularization: A Retrospective Cohort Study

TL;DR

This study found that hospital ownership type does not affect mortality for heart attack patients in shock but does affect healthcare costs.

Contribution

The study provides new evidence on the association between hospital ownership and healthcare costs in STEMI-induced cardiogenic shock patients.

Findings

Investor-owned hospitals had higher average charges compared to nonprofit hospitals.

Mortality rates were similar between investor-owned and nonprofit hospitals.

Length of stay was shorter in investor-owned hospitals but not clinically meaningful.

Abstract

Background

The healthcare landscape is notably divided between investor-owned and nonprofit hospitals, raising questions about the impact of hospital ownership on patient outcomes, especially for high-stakes conditions such as cardiogenic shock resulting from ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). This study analyzed whether differences in hospital ownership are associated with variations in mortality, length of stay (LOS), and healthcare costs.

Methodology

We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2016 to 2021, identifying 95,260 adult patients with STEMI-induced cardiogenic shock treated with PCI. Identification was based on validated International Classification of Diseases, Tenth Revision, Clinical Modification coding algorithms. The primary outcome was in-hospital mortality, with LOS and total hospital charges (inflation-adjusted via the Consumer Price Index) as secondary outcomes. All outcomes were assessed using multivariable regression models adjusting for patient demographics (age, sex, race/ethnicity), comorbidities, insurance type, and hospital-level factors (region, teaching status, and bed size). Regional cost variation and case mix were also accounted for. Propensity score matching was additionally performed to validate results.

Results

The analysis revealed no significant difference in mortality rates between investor-owned (27.22%) and nonprofit hospitals (26.93%, adjusted odds ratio (aOR) = 1.03, p = 0.60; 95% confidence interval (CI) = 0.91-1.16). Propensity score-matched analysis confirmed similar findings (aOR = 0.98, p = 0.696). Investor-owned hospitals, however, incurred significantly higher healthcare costs (average charges = $325,543 vs. $222,528; p < 0.001). The average cost difference of $103,015.50 remained statistically and systemically significant after adjustment and may reflect differences in resource utilization and/or billing practices. LOS was slightly shorter in investor-owned hospitals (6.51 vs. 7.27 days); while statistically significant (p < 0.001), this difference was not clinically meaningful after adjustment (coefficient = 0.19, p = 0.334). Key demographic and clinical predictors included age, insurance status, comorbidity index, hospital bed size, and teaching status. Racial and insurance-based disparities, particularly among Hispanic patients and Medicaid enrollees, were associated with higher costs, though not fully explained by hospital ownership.

Conclusions

In this national analysis, hospital ownership was not associated with differences in mortality for STEMI-induced cardiogenic shock treated with PCI, but was independently associated with substantially higher hospital charges in investor-owned hospitals. These findings demonstrate association, not causation, and highlight the need for future research into cost drivers and initiatives to promote high-value, standardized care across all hospital types.

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