Predictors of Financial Toxicity in Surgical Burn Injuries: A Multicentre Longitudinal Study
Hamaiyal Sana1, Anam Ehsan2, Chuan-Chin Huang2, Preet Hathi3, Nivedha Pillai4, Shivangi Saha3, Srinivasan Vengadassalapathy4, Praveen Ganesh4, Maneesh Singhal3, Andrea Pusic2, Kavitha Ranganathan2
1Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States; 2Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, United States; 3Department of Plastic Surgery, 3 All India Institute of Medical Sciences, New Delhi, India; 4Department of Plastic Surgery, 4Saveetha Medical College and Hospital Chennai, Tamil Nadu, India.
Patients with burns are at high risk for financial toxicity (FT) given the need for prolonged hospitalization, long-term rehabilitation, and ongoing disability from contractures. The burden of FT and cost of care among burn patients remains unclear. The goal of the current study is to define the extent of financial toxicity after burn injuries and the associated risk factors.
A multi-center, prospective, longitudinal study was designed to measure FT associated with burn patients requiring surgical management in India. The primary outcome FT was defined as catastrophic expenditure (healthcare costs >10% of annual household income) or using patient-reported FT measures. Multivariate logistic regression was used to evaluate clinical and sociodemographic predictors of FT.
Of the 106 patients, 55% incurred FT. Clinically, likelihood of FT was highest amongst those with greater length of hospitalization (OR=16.8;p=0.002) and injury severity (OR=19.6; p=0.04). Demographically, being female (OR=0.2;p=0.05) and having greater total income (OR=0.07;p=0.002) decreased FT likelihood (Table 1). Unemployment rates rose from 27% at baseline to 82% six months after surgery. Median preinjury income was (IQR=) and dropped to C:\inetpub\wwwroot\WebsiteHosting\NESPS\www.nesps.org\meeting\program\2023\P4.cgi (IQR=C:\inetpub\wwwroot\WebsiteHosting\NESPS\www.nesps.org\meeting\program\2023\P4.cgi) in the follow-up period. Up to 68% of patients reported being unable to afford basic subsistence needs, utilities, or rent during the six months following surgery.
More than half of all surgical burn patients developed FT. Risk factors included length of hospitalisation, injury severity, low-income, and poor job security. In addition to improving clinical outcomes, interventions like income support programs and job training alongside rehabilitation may reduce peri-operative FT rates in this cohort.
Back to 2023 Posters