• Jonathan E Williams, Sara L Schaefer, Ryan C Jacobs, Faelan Jacobson-Davies, Andrew M Ibrahim, and David D Odell.
• Department of Surgery, University of Michigan. Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan. Ann Arbor, MI. Electronic address: willjona@med.umich.edu.
• J. Thorac. Cardiovasc. Surg. 2025 Jan 15.

ObjectivePrivate equity acquisition of hospitals performing complex operations is increasingly prevalent in the United States healthcare landscape. While comparative health outcomes for common medical conditions have been investigated, the quality of thoracic surgical care in private equity-acquired hospitals is unknown.MethodsMedicare Beneficiaries, aged 65-99 years, undergoing elective lung resection between 2016 to 2020 were included. Private equity-acquired hospitals were identified using the Agency for Healthcare Research and Quality Health System Compendium. Postoperative outcomes, including 30-day mortality, complications, failure to rescue, readmission, and postoperative length of stay were risk-adjusted and compared to non-acquired hospitals using logistic regression considering patient age, sex, comorbidities, procedure type, and year of procedure.ResultsOf 144,223 beneficiaries undergoing lung resection, 11,140 (7.7%) received care at private equity-acquired hospitals. Private equity-acquired hospitals performed fewer lung resections annually (mean = 4.2) than non-acquired hospitals (mean = 10.5; p<0.001). Compared to non-acquired hospitals, patients treated at private equity-acquired hospitals demonstrated higher rates of 30-day mortality (2.1% vs 1.9%, OR 1.17 (1.03-1.33); p=0.019), serious complications (8.1% vs 6.8%, OR 1.29 (1.19-1.39); p<0.001), 30-day readmission (10.6% vs 9.9%, OR 1.08 (1.01-1.15); p=0.028), and longer postoperative length of stay (5.9 vs 5.3 days; p<0.001). Failure to rescue rates were not significantly different (9.8% vs 9.4%, OR 1.05 (0.90-1.23); p=0.518).ConclusionsThese findings raise concern that private equity-acquired hospitals may provide lower-quality care for patients undergoing common thoracic procedures. Underlying structural factors may contribute to these differences. This motivates further investigation of specialty surgical care performed at private equity-acquired health institutions.Copyright © 2025. Published by Elsevier Inc.

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