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Financial Toxicity in Emergency General Surgery: Novel Propensity-Matched Outcome Comparison.

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Area of Science:

  • Surgery
  • Health Economics
  • Patient Outcomes

Background:

  • Financial toxicity, stemming from treatment costs and fiscal burdens, negatively impacts surgical outcomes.
  • While studied in surgical oncology, its effect on emergency general surgery (EGS) patients is less understood.
  • This study novelly explores financial toxicity's impact on EGS patients across the US.

Purpose of the Study:

  • To investigate the impact of financial toxicity on outcomes in emergency general surgery (EGS) patients.
  • To analyze the association between financial toxicity and mortality, VTE, LOS, and readmission rates in EGS.
  • To identify differences in comorbidity burden between EGS patients with and without financial toxicity.

Main Methods:

  • Utilized the Nationwide Readmissions Database (January-February 2018) for EGS patients aged 18-65.
  • Employed one-to-one propensity matching to compare patients with and without financial toxicity risk.
  • Primary outcome: mortality. Secondary outcomes: VTE, prolonged LOS, 30-day readmission.

Main Results:

  • 24,154 EGS patients were propensity matched.
  • No significant difference in mortality (0.2%) or VTE (0.5%) between groups.
  • Increased risk of prolonged LOS (RR 1.24) and 30-day readmission (RR 1.21) for patients with financial toxicity (p < 0.001).
  • Patients at risk for financial toxicity had more comorbidities upon readmission.

Conclusions:

  • Financial toxicity in EGS patients is linked to increased LOS and readmission risk, but not mortality or VTE.
  • Patients with financial toxicity present with fewer identified comorbidities at index admission compared to readmission.
  • Future research should focus on mitigating financial toxicity and improving comorbidity identification in EGS to enhance patient outcomes.