Hospital acquisitions and 30-day mortality after acute myocardial infarction and stroke in Germany: a quasi-experimental cohort study.
prospective_cohort · Level II
Where this comes from
- Record sourced from PubMed, PMID 42540482.
- Also identified by DOI 10.1016/j.lanepe.2026.101788 and PMC identifier 13425888.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Hospital consolidation has intensified globally, but evidence regarding its association with clinical quality remains mixed, particularly in universal healthcare systems with regulated prices. We assessed whether hospital acquisitions were associated with changes in 30-day excess mortality for acute myocardial infarction (AMI) and stroke. This quasi-experimental cohort study used a staggered difference-in-differences design analyzing German hospitals providing AMI or stroke care (2009-2019). We compared performance changes three years pre- and post-acquisition between acquired hospitals (n = 125 for AMI; n = 121 for stroke) and control hospitals with stable ownership (n = 821 for AMI; n = 830 for stroke). Primary outcomes were 30-day excess mortality rates. Secondary outcomes included medical staffing intensity and the provision of cardiac catheterization laboratories and stroke units. Acquisition was associated with a 1.24 percentage-point (pp) decline in excess 30-day AMI mortality within three years (95% CI -2.04 to -0.44; p = 0.002). This improvement coincided with a 6.63 pp increase in the probability of providing cardiac catheterization laboratories (0.75 to 12.52; p = 0.03). For stroke, the association with excess 30-day mortality indicated a clinically relevant but statistically insignificant 0.43 pp decline (-1.38 to 0.53; p = 0.44). Nurse staffing intensity transiently increased during the acquisition year for both AMI and stroke. In a regulated, fixed-price system, acquisitions were significantly associated with reduced AMI mortality and expanded interventional infrastructure. Findings suggest consolidation can improve clinical quality by unlocking capital for life-saving investments. While capital-intensive conditions like AMI benefit rapidly, complex care pathways like stroke likely require additional clinical integration strategies. German Research Foundation.