Examining Quality of Care at “Safety-Net Hospitals”

Clinical investigators at Texas Heart Institute and Baylor College of Medicine recently compared the nationwide outcomes of surgical valve-replacement procedures at safety-net and non–safety-net hospitals. When the investigators matched data from patients according to their preoperative risk factors, their analysis revealed similar rates of in-hospital mortality, morbidity, and readmissions between the two hospital types but identified opportunities for improvement in length of stay and related costs at safety-net hospitals.

In the United States, certain hospitals are designated as “safety-net hospitals”: centers where patients can get treatment regardless of their ability to pay. These hospitals play an important role in the health care system by providing access to health care for patients with lower incomes.

Because of these patients’ economic disadvantages, their overall condition when they present for surgery is often worse—in that their disease is more advanced, and the patients have more comorbid conditions—than that of patients at non–safety-net hospitals. As a result, surgery at safety-net hospitals tends to be associated with greater postoperative morbidity and mortality.

As reported in their recent article, titled “Outcomes, Cost, and Readmission After Surgical Aortic or Mitral Valve Replacement at Safety-Net and Non–Safety-Net Hospitals” and published in the Annals of Thoracic Surgery, surgeons William Frankel, MD, Ravi Ghanta, MD, and colleagues used the National Readmissions Database to compare the results of more than 109,000 aortic valve replacement and mitral valve replacement operations performed at centers across the United States between 2016 and 2018. About 16% of these procedures were performed at safety-net hospitals. The investigators hypothesized that when patients treated at safety-net hospitals and non–safety-net hospitals were matched in terms of their preoperative risk factors (e.g., age, congestive heart failure, chronic kidney disease), the two groups would have similar outcomes.

One surprising finding was that even without the propensity-matching, the safety-net hospitals and non–safety-net hospitals had similar in-hospital mortality rates: just over 2% for aortic valve replacement, and about 4.5% for mitral valve replacement. And after propensity-matching, patients at safety-net hospitals and non–safety-net hospitals had similar postoperative morbidity and readmission rates, as well.

“But despite this adjustment for preoperative risk,” says Dr. Ghanta, “patients treated at safety-net hospitals still had longer hospital stays and, therefore, greater hospital costs than patients treated at non–safety-net hospitals. We believe this finding highlights the potential importance of improving discharge options for low-income patients so that they do not need to spend as much time in the hospital after surgery.”

Read Report

Frankel WC, Sylvester CB, Asokan S, Ryan CT, Zea-Vera R, Zhang Q, Wall MJ Jr, Preventza O, Coselli JS, Rosengart TK, Chatterjee S, Ghanta RK. Outcomes, Cost, and Readmission After Surgical Aortic or Mitral Valve Replacement at Safety-Net and Non–Safety-Net Hospitals. Ann Thorac Surg. 2022 Feb 22. doi: 10.1016/j.athoracsur.2022.01.049.

News Story By Stephen N. Palmer, PhD, ELS