Variable surgical outcomes after hospital consolidation: Implications for local health care delivery

Abstract

With more hospital consolidations as an inevitable part of our future health care ecosystem, we investigated the relationship between hospital consolidations and operative outcomes. Using the Health Care Cost and Utilization Project State Inpatient Database (Florida and California), the American Hospital Association Annual Survey Database, and Medicare's Case Mix Index data, we identified 19 hospitals that consolidated between 2007 and 2013 and propensity matched them with 19 independent hospitals, using patient and hospital characteristics. One year before consolidation and again 1year after, we used difference-in-differences analysis to compare changes in the risk-adjusted complication rate of 7 elective operations performed in the consolidated hospitals and in the matched control group. Of the 7 procedures studied, 2 procedures saw a decrease in complication rate (lumbar and lumbosacral fusion of the posterior column posterior technique, difference-in-differences=-0.6%, P<.01; total hip replacement, difference-in-differences=-0.6%, P<.01); 3 procedures saw an increase in complication rate (transurethral prostatectomy, difference-in-differences=4.1%, P<.01; cervical fusion of the anterior column anterior technique, difference-in-differences=1.5%, P<.01; total knee replacement, difference-in-differences=0.3%, P<.01); and 2 procedures saw no change in complication rate (laparoscopic cholecystectomy, lumbar and lumbosacral fusion of the anterior column posterior technique, both P>.05) after hospital consolidation. Arguments have been made that consolidated health care systems can share high-performing clinical services and infrastructure resources, such as electronic medical records, to improve quality. Our results indicate that hospital consolidation does not uniformly improve postoperative complication rates.