Background: Emergency general surgery (EGS) accounts for approximately 11% of all annual hospitalizations in the United States (U. S. ) and represents a particularly vulnerable patient population. Termed “financial toxicity, ” unexpected surgical admissions can result in significant financial hardship, which is associated with lower quality of life, severe psychological distress, and poor health outcomes. This study aimed to investigate the risk of financial toxicity among patients requiring admission for common EGS pathologies. Methods: All privately insured and uninsured patients who were admitted for the top five most common EGS conditions (biliary disease, appendicitis, diverticulitis, small bowel obstruction, and inguinal hernia) were identified from the National Inpatient Sample database from 2015 to 2019 using the International Classification of Diseases, 10th Revision, Diagnostic and Clinical Modification procedure codes. The risk of financial toxicity was defined as hospital expenditure greater than 40% of post-subsistence income. Results: Out of the 136 431 EGS admissions identified, 82% were privately insured, and 18% were uninsured. The overall median admission cost for EGS admission was 11 660 USD (interquartile range: 8505–17 233). Approximately 47. 6% (95% CI: 46. 9%–48. 2%) of uninsured patients and 0% of privately insured patients were at risk of catastrophic expenditure. Predictors of financial toxicity included male sex, younger age (18–39 years), Black or Hispanic race, low residential income, greater comorbidities, and treatment at a rural or non-teaching hospital. Conclusion: Approximately half of uninsured EGS patients were at risk of financial toxicity. Targeted financial protection interventions for those at risk of financial toxicity are needed.
Park et al. (Tue,) studied this question.