"After Surgery, I Filed for Bankruptcy."The Financial Ramifications of Unexpected Surgery for Upper Extremity Trauma.

Abstract

Traumatic injuries of the upper extremity and hand (UE) can result in notable financial ramifications particularly if they involve surgical intervention. Although most studies in orthopaedics address direct costs, little is known about the personal experience with financial distress following UE trauma surgery. Fourteen patients, identified as having markedly high financial distress using self-reported validated surveys, who received UE trauma surgery were interviewed. Semistructured interviews were conducted until thematic saturation was achieved after sequential thematic analysis by two independent researchers. Interviews were recorded, transcribed, and qualitative methodology was used to create a final conceptual model. Most patients (57%) were female, uninsured (36%) with an average age of 37.7 years. Distal radius fractures (29%) were the most common injuries, and most injuries received open reduction and internal fixation (71%). A total of 14 unique, overarching subthemes emerged, which were collated to create a conceptual model comprising (1) community and personal impact; (2) insurance challenges and legal struggles; and (3) consequences of debt and catastrophic loss. Methods for improving support for future patients also emerged during the interview process. The costs related to upper extremity trauma surgery affects patients' families and communities and may result in unexpectedly large material loss and distress beyond the known direct physical impact of injury, such as the loss of access to care, inadequate insurance coverage, and inability to self-actualize. Understanding these reverberating effects is critical, as surgeons seek to holistically understand, care for, and study the patient experience after surgery while also effectively advocating for targeted interventions in policy. Prognostic Level II.