Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
Colorectal Dis. 2024 Apr;26(4):692-701. doi: 10.1111/codi.16903. Epub 2024 Feb 14.
Financial toxicity describes the financial burden and distress that patients experience due to medical treatment. Financial toxicity has yet to be characterized among patients with inflammatory bowel disease (IBD) undergoing surgical management of their disease. This study investigated the risk of financial toxicity associated with undergoing surgery for IBD.
This study used a retrospective analysis using the National Inpatient Sample from 2015 to 2019. Adult patients who underwent IBD-related surgery were identified using the International Classification of Diseases (10th Revision) diagnostic and procedure codes and stratified into privately insured and uninsured groups. The primary outcome was risk of financial toxicity, defined as hospital admission charges that constituted 40% or more of patient's post-subsistence income. Secondary outcomes included total hospital admission cost and predictors of financial toxicity.
The analytical cohort consisted of 6412 privately insured and 3694 uninsured patients. Overall median hospital charges were $21 628 (interquartile range $14 758-$35 386). Risk of financial toxicity was 86.5% among uninsured patients and 0% among insured patients. Predictors of financial toxicity included emergency admission, being in the lowest residential income quartile and having ulcerative colitis (compared to Crohn's disease). Additional predictors were being of Black race or male sex.
Financial toxicity is a serious consequence of IBD-related surgery among uninsured patients. Given the pervasive nature of this consequence, future steps to support uninsured patients receiving surgery, in particular emergency surgery, related to their IBD are needed to protect this group from financial risk.
财务毒性描述了患者因医疗而承受的经济负担和困扰。在接受手术治疗炎症性肠病（IBD）的患者中，尚未对其进行财务毒性的特征描述。本研究调查了与 IBD 手术相关的财务毒性风险。
本研究使用了 2015 年至 2019 年国家住院患者样本的回顾性分析。使用国际疾病分类（第 10 次修订版）诊断和程序代码识别接受 IBD 相关手术的成年患者，并将其分为私人保险和无保险组。主要结果是财务毒性风险，定义为构成患者生存后收入 40%或以上的医院住院费用。次要结果包括总住院费用和财务毒性的预测因素。
分析队列包括 6412 名私人保险患者和 3694 名无保险患者。总体中位数医院收费为 21628 美元（四分位距 14758-35386 美元）。无保险患者的财务毒性风险为 86.5%，而有保险患者则为 0%。财务毒性的预测因素包括急诊入院、处于最低收入四分位数和患有溃疡性结肠炎（与克罗恩病相比）。其他预测因素包括黑人和男性。
财务毒性是无保险患者 IBD 相关手术的严重后果。鉴于这种后果的普遍存在，需要采取未来的步骤来支持接受与 IBD 相关的手术（尤其是急诊手术）的无保险患者，以保护这一群体免受财务风险。
