The Hidden Impact of Compounding Financial Toxicity In Surgical Oncology: National Analysis of Different Hospital Readmission

Keywords: Surgical Oncology, Financial Toxicity, Readmissions

Synopsis: Financial toxicity has been demonstrated to lead to poor quality of life and poor treatment outcomes in surgical oncology patients. Few prior studies of these patients include repeated hospitalizations to different hospitals. The purpose of this study was to evaluate the impact of financial toxicity on hospital readmissions in surgical oncology patients including different-hospital readmissions.

Methods: The Nationwide Readmissions Database for 2018 was queried for all patients aged 18 to 64 years with a primary admitting diagnosis of a surgically treated malignancy. Patients impacted by financial toxicity were identified by the presence of two or more of the following: lack of insurance, household income in the lowest quartile, or index hospitalization cost in the highest quartile. The primary outcome was readmission within thirty days. The secondary outcome was readmission to a different hospital within 30 days. Univariable analysis was performed using a chi-squared test. Multivariable logistic regression was performed with all the significant variables from univariable analysis. Results were weighted for national estimates.

Results: There were 108,850 patients identified meeting inclusion criteria. The rate of readmission was 17.4% (n=18,959) and from these readmitted patients, 19.1% (n=3,611) were readmitted to a different hospital. Financial toxicity was identified in 7.3% (n=7,888) of patients and their readmission rate was 20.1% (n=1,585, p<0.001). After controlling for confounding factors using multivariable logistic regression, the strongest risk factor for readmission was more than 3 comorbidities (OR 1.74 [1.68-1.79] p<0.001). Financial toxicity was also a significant risk factor for readmission (OR 1.11 [1.05-1.18] p<0.001).

Conclusions: Surgical oncology patients impacted by financial toxicity are at increased risk for hospital readmission within 30 days. Readmission studies from single institutions miss a large portion of these patients with this compounding risk. Continuity of care and outcome improvements can be achieved by efforts to reduce the financial burdens placed on surgical oncology patients.