Nashville ? The board of HCA Inc. is recommending the nation’s largest for-profit hospital operator accept a $21.3 billion deal to take the company private in one of the largest leveraged buyouts ever.

The deal, which would involve the assumption of $11.7 billion in debt, comes while HCA is struggling with sliding earnings, slow growth and escalating costs for uninsured patients.

The buyout would take the Nashville-based company private for the second time since its initial public offering in 1969, and it would give HCA time to turn around its market performance.

Shareholders of the company, which was founded by the family of Senate Majority Leader Bill Frist, would receive $51 in cash for each share of common stock under the deal announced Monday. Frist sold his shares in the company in June 2005.

Shares of HCA rose $1.61, or 3.4 percent, to close at $49.48 on the New York Stock Exchange.