Elective Surgery in Private Sector Linked to Shorter Stays and Fewer Readmissions Than NHS

Priscilla Lynch 

September 08, 2021

NHS-funded elective surgery performed in the independent hospital sector in England is associated with shorter lengths of stay and lower readmission rates than the same treatment in NHS hospitals, finds observational research published online in  BMJ Quality & Safety.

To explore concerns on whether NHS patients receive the same level of care in the independent sector as they would in an NHS hospital, the researchers examined national Hospital Episode Statistics data for 18 common surgical procedures performed between 2006 and 2019.

The procedures included impacted wisdom tooth removal, cholecystectomy, endoscopic resection, hysterectomy, hernia repair, nerve decompression of the lower lumbar spine and hip and knee replacements. The data set included 3,203,331 operations in 734 NHS hospitals and 468,259 operations in 274 independent hospitals.

Across all 18 included operation types, the length of stay was significantly longer for patients treated in NHS hospitals compared with those treated in independent hospitals. Effect sizes ranged from an HR of 2.15 (95% CI, 1.72-2.68) for total hip replacement to 1.07 (95% CI, 1.05-1.09) for wisdom tooth removal, a mean difference of 2.49 and 0.02 days, respectively.

Treatment at an independent hospital was also associated with a lower risk of emergency readmission compared with NHS treatment. HRs ranged from 0.36 (95% CI, 0.28-0.46) for lumbar decompression to 0.75 (95% CI, 0.67-0.85) for cholecystectomy with absolute risk differences of 1.5 and 1.3 percentage points, respectively.

Patients in independent hospitals were more likely to be transferred to other hospitals as an emergency, whereas inpatient deaths and non-emergency transfers were more likely for patients treated in NHS hospitals.

There was no difference in the overall mortality.

Patients treated in the independent sector were, on average, older, but they had fewer underlying conditions, lived in more affluent areas and tended to be White (or had no ethnicity recorded) than those treated in NHS hospitals.

The study authors concluded: “Plausible concerns have been expressed regarding the safety of elective surgery in the independent sector. Taken in the round, our findings provide a measure of reassurance that independent sector healthcare providers are providing an acceptable service."

“In the context of meeting the backlog of cases following the COVID-19 pandemic this may be a useful finding. But our results stop short of total reassurance, and ongoing scrutiny of a richer set of outcomes and further investigation of practice is required in both the NHS and [the independent sector].”

Crothers H, Liaqat A, Reeves K, Watson SI, Gallier S, Khunti K, Bird P, Lilford R. Outcomes for surgical procedures funded by the English health service but carried out in public versus independent hospitals: a database study. BMJ Qual Saf. 2021 Sep 7 [Epub ahead of print]. doi: 10.1136/bmjqs-2021-013522.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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