November 2025

This retrospective cohort study finds a significant difference in 30-day post-operative mortality – specifically because of failure to rescue (i.e., prevent death among patients with post-op complications) – for common general surgery procedures when comparing hospitals recently acquired by private equity (PE) firms versus non-PE hospitals. 

Summary: Private equity (PE) firms have played an increasing role in American health care over the past decade, with a notable focus on restructuring healthcare organizations to maximize profitability. PE firm acquisitions increasingly concern inpatient surgical care, and there has been limited analysis thus far on the effects of these acquisitions on care quality. In this study, the authors used the Medicare Provider Analysis and Review Files (2011-2020), linked to the American Hospital Association Annual Survey, to review all claims for colectomies, cholecystectomies, appendectomies, and incisional hernia repairs. Exposure was acquisition of a US non-PE hospital by a PE firm. The primary outcome was 30-day post-operative mortality. Secondary outcomes were any/serious complication, failure to rescue, and 30-day readmission.

The results showed that 22,446 surgical episodes (7.5% of total) occurred at PE-acquired hospitals (67/701 total). These hospitals were typically <200 beds and located in urban/suburban areas of the U.S. South and West. Adjusted difference-in-difference analyses showed that PE acquisition was associated with increased 30-day postoperative mortality (+2.7%) and an increased failure to rescue (+3.9%). No significant associations were seen for other secondary outcomes. On subset analysis, these differences were seen primarily in patients who underwent emergent surgery as opposed to elective surgery.

Limitations of the study include generalizability since the study population was Medicare patients. Additionally, there are some limitations in internal validity since there is selection bias from non-random acquisition of hospitals by PE firms as well as coding bias, thus potential confounding by factors not captured in administrative data.

Bottom Line: This study finds a significant increase (+2.7%) in 30-day post-operative mortality for patients undergoing emergent surgical procedures at hospitals acquired by PE firms during the study period, which appears attributable to failure to rescue. This increase in failure to rescue suggests issues in recognizing and managing complications and may be due to an observed relative reduction in registered nurse FTEs at PE hospitals.

This study from France of more than 18,000 kidney transplant recipients evaluates the impact of delayed graft function (DGF, the acute need for dialysis following transplant) on cardiovascular morbidity and mortality. They found that kidney transplant recipients who had DGF were at increased risk of major adverse cardiovascular events, and this association intensified with greater DGF severity. 

Summary: Kidney transplant provides improved overall survival for patients with end stage renal disease over dialysis; however, cardiovascular disease remains highly prevalent among kidney transplant recipients (KTRs). Delayed graft function (DGF) is characterized as acute kidney injury in KTRs and is defined as need for at least 1 dialysis session in the 7 days post-transplant. It has previously been associated with worse transplant outcomes such as graft survival, and all-cause mortality though the mechanisms are not fully understood. In this study, the authors explored the idea that acute kidney injury, such as in KTRs experiencing DGF, may increase cardiovascular risk. They did this using a retrospective multicenter cohort study of 17 transplant centers, and 18,149 KTRs from 2008-2022, facilitated by a national centralized network. The primary outcome was major adverse cardiovascular events (MACEs), including death, coronary artery disease, heart failure and stroke. Secondary outcomes included graft failure, non-cardiovascular death, and all-cause death. Kaplan-Meier analysis was used to estimate the cumulative incidence of MACEs, as well as with competing risk assessment using Gray method. Multivariable cause-specific Cox proportional hazards models were used to evaluate associations between DGF and each of the outcomes, adjusting for center effect and potential confounders. 

Among 18,149 KTRs, 23% experienced DGF, 12.8% experienced at least one MACE, 11.1% had graft failure, and 17.4% died during the follow up period. MACEs were characterized as CAD-related events (26.4%), heart failure episodes (53.6%), stroke (12.3%) and cardiovascular death (9.3%). KTRs with DGF had an increased incidence of MACEs, with rising incidence over time (10.4% at 1 year, 16.7% at 5 years), while those without DGF were significantly less likely to have MACEs (5.2% at 1 year, 9.7% at 5 years). DGF was associated with coronary artery disease, heart failure, and cardiovascular death but not with stroke. Additionally, there was a significant association between DGF and graft failure and non-cardiac death at 10 years. 

In summary, DGF was associated with a 24% increased hazard of MACE, with this being independent of the calculated glomerular filtration rate at 3 months post-transplant. The increased risk was higher in populations with typically low cardiovascular risk, such as women, patients without diabetes or without cardiovascular disease history, and was persistent across time (ie, beyond 1 year, out to 5+ years). The risk of MACE increased with higher severity of DGF (requiring more than 1 dialysis session). Study limitations include retrospective trial design and unaccounted for/residual confounders.

Bottom line: This study investigated the downstream risk to KTRs who experience DGF, showing durable increased risk of MACEs post-transplant, even when there is expedient graft recovery. KTRs remain a high-risk group for cardiovascular morbidity and mortality post-transplant, highlighting the importance preventative medical therapies to minimize risks.