Society for Surgery of the Alimentary Tract
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Yung Lee2,1, Sama Anvari*2, Adelia Padoan2, Tyler Mckechnie2, Cagla Eskicioglu2, Aristithes Doumouras2, Dennis Hong2
1Harvard University T H Chan School of Public Health, Boston, MA; 2McMaster University, Hamilton, ON, Canada

BACKGROUND: Financial toxicity describes the financial burden and distress that can arise for patients as a result of medical treatment. Financial toxicity is well-studied in patients with inflammatory bowel disease but has yet to be characterized amongst surgical patients. This study aims to define the risk of financial toxicity associated with undergoing surgery related to inflammatory bowel disease.

METHODS: A retrospective analysis using the National Inpatient Sample from 2015 to 2019 was conducted. Adult patients that underwent surgery related to inflammatory bowel disease were identified using the International Classification of Diseases, 10th revision diagnostic and procedure codes. Patients were stratified into privately insured and uninsured groups. The primary outcomes measured were the proportion of patients' risk of financial toxicity, inpatient hospital admission cost, and the predictors of financial toxicity amongst uninsured patients. Patients were said to be at risk for financial toxicity if their hospital admission charges constituted 40% or more of patient income.

RESULTS: The analytic cohort consisted of 6,412 privately insured and 3,694 uninsured patients. The median unadjusted inpatient admission charges were higher amongst uninsured patients ($24,040; IQR: $15,602-$39,765) than privately insured patients ($20,626; IQR: $14,364-$32,832), with 86.5% of uninsured patients at risk of catastrophic expenditure. Compared to other races, Hispanic patients had the highest median admission costs ($26,327; IQR $16,222-$44,347). Predictors of financial toxicity within uninsured patients included female sex, black patients, lowest income quartile, emergent admission, and ulcerative colitis over Crohn's disease.

CONCLUSION: Financial toxicity is a serious consequence of inflammatory bowel disease-related surgery amongst uninsured patients. Given the pervasive nature of this consequence, future steps to support uninsured patients receiving surgery related to their inflammatory bowel disease are needed to protect this group from financial risk.

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