Evaluating Financial Toxicity and Quality of Life Among Acute Care Surgery Patients: A Mixed-Methods Study.

Abstract

Acute care surgery (ACS) patients face financial burdens and impact on quality of life (QoL), which can be significant for the uninsured. Hospital Presumptive Eligibility (HPE) aims to reduce costs and improve access. We evaluated patient-reported outcomes after hospitalization, hypothesizing that HPE improved recovery trajectory. A convergent mixed-methods study of ACS patients 18 to 64 years was performed at an academic Level I trauma center from December 2024 to August 2025. HPE patients were compared with insured patients. Twelve-Item Short Form Health Survey QoL and American Association for the Surgery of Trauma financial hardship survey tool were completed at hospitalization and 1 to 3 months postdischarge. Thematic analysis of semistructured interviews was conducted to evaluate access to care and financial toxicity. Ten of the 110 patients were HPE and the rest were insured controls. HPE patients were younger (median: 39.5 vs 43.5 years), had higher ICU admission (30% vs 9%) and nonroutine discharge (22% vs7%) rates. At 3 months postdischarge, both groups had reduced household income (HPE vs controls: 33% vs 20%) and difficulty paying nonmedical bills (50% vs 25%). HPE patients additionally reported lower 12-Item Short Form Health Survey measures. In qualitative analysis, HPE patients cited rapid access to insurance and expected reduction in out-of-pocket cost as program benefits. Risk for financial toxicity remains high among ACS patients. Patients enrolled on HPE faced additional financial and psychosocial strains during postadmission recovery. QoL and financial metrics are important to understand longitudinal patient outcomes and guide policies to improve patient recovery.