Financial Hardship After Surgical Procedures.
Level 3 - non-randomized controlled study
Retrospective matched cohort study with difference-in-differences analysis using national survey data.
PubMed 41259019 · doi:10.1001/jamasurg.2025.5055
What was done
This retrospective cohort study used Medical Expenditure Panel Survey (MEPS) data from 2014 to 2021 to examine the association between surgical procedures and financial hardship in noninstitutionalized US adults aged 18 to 64 years. Patients reporting a surgical procedure within the prior 12 months were matched to nonsurgical controls using coarsened exact matching on age, sex, race, ethnicity, income, insurance payer, census region, comorbidities, and survey year. The primary outcome was financial hardship (problems paying medical bills or delaying care due to cost) and the secondary outcome was family out-of-pocket spending, evaluated via difference-in-differences models.
What was found
Among a weighted sample representing 40 million working-aged adults (62% female, 38% male), 37.9% of surgical patients experienced financial hardship postoperatively. Surgery was associated with an overall 5.4-percentage point increase (95% CI, 1.8 to 9.0; a 16% relative increase) in financial hardship. Hardship increased by 23.7 percentage points (95% CI, 5.1 to 42.2) in uninsured patients and 8.4 percentage points (95% CI, 3.6 to 13.1) in privately insured patients, whereas Medicaid enrollees experienced no significant change. Family out-of-pocket spending increased by an average of $708 (95% CI, $576 to $839), with the largest rises occurring after emergency surgery and among non-Medicaid patients.
Why it matters
This study shows that surgical interventions drive measurable financial hardship among working-aged US adults, affecting privately insured as well as uninsured individuals. It also provides empirical evidence that Medicaid enrollment provides strong protection against surgical financial toxicity.
Limits
The study relies on self-reported survey data, which is subject to recall and reporting bias. Unweighted sample size is not reported in the abstract. Findings are restricted to noninstitutionalized working-aged adults (18–64) and cannot be generalized to Medicare-eligible adults aged 65 and older. Residual confounding may persist despite coarsened exact matching.
Cited by
- supports Between 40 and 50 million surgical procedures are performed annually in the United States.