The Unseen Cost Of Trauma: Unemployment And Homelessness Following Plastic Surgery

PURPOSE: Plastic surgery trauma patients are at high risk for disability post-injury. This can affect one's ability to work, generate income, and afford housing. The longitudinal trajectory of job security and ability to afford basic needs after trauma remains unclear. The goal of this study is to track and quantify unemployment and homelessness after plastic surgery-specific trauma. METHODS: A prospective, multicenter cohort study was conducted including post-trauma plastic surgery inpatients across three tertiary hospitals. Patients were surveyed for sociodemographics, clinical outcomes, and social determinants of health at 1-, 3- and 6-months post-operatively. The primary outcome was new unemployment or homelessness postoperatively, with multivariate logistic regression utilized to determine predictors of outcomes. RESULTS: Of 781 patients, 19.1%(n=149) were newly unemployed at one month, and 45.1% (n=352) by six months post-operatively. Homelessness affected 7.3% (n=57) of patients at one month, increasing to 13.6% (n=106) at six months post-operatively. New unemployment was most strongly associated with ICU admission (OR=1.39[1.18,1.63], p<0.001), increased injury severity (OR=1.21[1.09,1.35], p<0.001), and no insurance (OR=1.27[1.12,1.44], p<0.001). New homelessness was most strongly associated with increased injury severity (OR=1.15 [1.06, 1.25], p<0.001), larger hospital bills (OR=1.10 [1.05,1.13], p<0.001), and decreased household income (OR=1.11 [1.08, 1.16], p<0.001). CONCLUSION: Unemployment and homelessness increase steadily over six months for plastic surgery trauma patients. Identifying high-risk patients presenting with disability from greater injury severity, and at risk for financial toxicity postoperatively is imperative. Tailored, injury-specific social rehabilitation services are required to prevent these adverse outcomes.