Increased Medical Debt in Collections 1 Year After Emergency General Surgery Admission

Emergency general surgery (EGS) conditions account for 4 million unplanned hospital admissions annually, but whether these acute, usually curable conditions are associated with lasting medical debt is unknown. We hypothesized that post-EGS increases in medical debt would be more strongly associated with patient demographics than treatment factors.

We evaluated 4,216 adults admitted for appendicitis, gallbladder disease, small bowel obstruction, or emergency laparotomy in a statewide EGS collaborative (April 2020-June 2021), linking clinical registry data to quarterly consumer credit reports from 1 year before through 1 year after admission. The primary outcome was any increase in medical debt in collections from admission to 12 months; the secondary outcome was debt magnitude among affected patients. Modified Poisson and negative binomial regression evaluated incidence and magnitude, respectively.

Overall, 382 patients (9.1%) had increased medical debt in collections (mean increase $1,764; median $535). Estimated income demonstrated a dose-response relationship (15.2% <$40,000 vs 2.7% >$100,000; aRR 5.67, 95% CI 3.69-8.69). Uninsured patients had 4.06-fold higher risk than privately insured patients (95% CI 2.82-5.84; adjusted probability 29.5% vs 7.3%). Operative intervention, intensive care, and hospital length of stay were not associated with increased debt.

Nearly 1 in 10 patients had increased medical debt in collections after EGS. Associations with income and insurance, but not treatment intensity, identify financial risk protection rather than changes in clinical care as a target for reducing post-EGS financial hardship.