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Difficulty wise this is pretty much the same as the first book in the series, I didn't notice anything significantly harder or easier.
I'll call out that when I first started this book I didn't really see how the two were connected and thought it was just 'oh, suspense involving hospitals and clowns?' but rest assured this is very much a sequel and you should not read this one without having read the second one unless you're ok with the first book being thoroughly spoiled.
I actually read the first 200ish pages of this in one shot on the start of a trip, and then finished it in 30-50 page chunks. It's a fast read thriller and the story is full of twists and intrigue. I liked the character relationships and the evolving storyline as backgrounds and motives are revealed.
No slow spots in the entire read for me, very nicely paced. Highly recommend if you enjoy suspense/thrillers. The specific theme of this one is a real-life escape game.