Title: Association of For-Profit Status and Outcomes in Management of Trauma Patients

Author: Nam Yong Cho

Area of Concentration (Petal): Basic, Clinical, and Translational Research

Specialty (if any): Trauma Surgery

Keywords: For-profit Hospitals, Private Equity, Nonprofit Hospitals, Trauma Center, Clinical Outcomes

Background: In recent years, for-profit hospitals have expanded in the vicinity of established trauma centers. Moreover, private equity firms have increasingly invested in for-profit institutions. However, there remains a paucity of data on the clinical outcomes of patients managed at for-profit centers.

Objective: To assess the association between the for-profit status of trauma centers and clinical outcomes among trauma patients using a national data set.

Methods: All trauma patients 16 years or older were identified using the 2018-2021 American College of Surgeons Trauma Quality Improvement Program. Patients were stratified into those managed at for-profit and nonprofit trauma centers and by trauma center level. Multivariable regression models were utilized to assess the association of for-profit status with in-hospital mortality, perioperative complications, length of stay (LOS), intensive care unit (ICU) stay, and discharge to hospice.

Results: Among 2,555,265 patients, 356,609 (14.0%) were managed at for-profit trauma centers. Compared to nonprofit centers, trauma patients at for-profit centers were older (58 [35-74] vs 54 [33-72] years, SMD=0.11) with a similar proportion of female patients (43.8 vs 40.9%, SMD=0.06). Trauma patients at for-profit institutions had lower median injury severity scores (8 [4-10] vs 9 [4-10], SMD=0.11) compared to those managed at nonprofit centers. Following risk adjustment, for-profit and nonprofit Level I trauma centers demonstrated comparable in-hospital mortality. At Level II and III trauma centers, for-profit status was associated with reduced odds of mortality (Adjusted Odds Ratio [AOR] 0.86. 95% Confidence Interval [95%CI] 0.75-0.93). Additionally, for-profit status was associated with increased hospital duration of stay as well as odds of discharge to hospice at both Level I (AOR 2.33, 95%CI 1.71-3.18) and Level II/III (AOR 2.08, 95%CI 1.78-2.45) trauma centers.

Conclusions: Improved standardization across for-profit and nonprofit institutions may improve the outcomes of trauma patients in the US. Governing bodies should carefully assess and facilitate the role of for-profit trauma centers in the landscape of current trauma system expansion.