Purpose
Brachial plexus injuries (BPIs) are devastating to patients not only functionally
but also financially. Like patients experiencing other traumatic injuries and unexpected
medical events, patients with BPIs are at risk of catastrophic health expenditure
(CHE) in which out-of-pocket health spending exceeds 40% of postsubsistence income
(income remaining after food and housing expenses). The individual financial strain
after BPIs has not been previously quantified. The purpose of this study was to assess
the proportion of patients with BPIs who experience risk of CHE after reconstructive
surgery.
Methods
Administrative databases were used from 8 states to identify patients who underwent
surgery for BPIs. Demographics including age, sex, race, and insurance payer type
were obtained. Inpatient billing records were used to determine the total surgical
and inpatient facility costs within 90 days after the initial surgery. Due to data
constraints, further analysis was only conducted for privately-insured patients. The
proportion of patients with BPIs at risk of CHE was recorded. Predictors of CHE risk
were determined from a multivariable regression analysis.
Results
Among 681 privately-insured patients undergoing surgery for BPIs, nearly one-third
(216 [32%]) were at risk of CHE. Black race and patients aged between 25 and 39 years
were significant risk factors associated with CHE. Sex and the number of comorbidities
were not associated with risk of CHE.
Conclusions
Nearly one-third of privately-insured patients met the threshold for being at risk
of CHE after BPI surgery.
Clinical Relevance
Identifying those patients at risk of CHE can inform strategies to minimize long-term
financial distress after BPIs, including detailed counseling regarding anticipated
health care expenditures and efforts to optimize access to appropriate insurance policies
for patients with BPIs.
Key words
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Article info
Publication history
Published online: January 30, 2023
Accepted:
December 8,
2022
Received:
July 27,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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