Journal of the American College of Surgeons · 2026
Increased Medical Debt in Collections 1 Year After Emergency General Surgery Admission.
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Johnson Patrick L, Mullens Cody L, Levy Scott C, Jean Raymond, Hemmila Mark R, Scott John W
Аннотация
BACKGROUND: Emergency general surgery (EGS) conditions account for 4 million unplanned hospital admissions annually, but whether these acute, usually curable conditions are associated with lasting medical debt is unknown. We hypothesized that post-EGS increases in medical debt would be more strongly associated with patient demographics than treatment factors.
STUDY DESIGN: We evaluated 4,216 adults admitted for appendicitis, gallbladder disease, small bowel obstruction, or emergency laparotomy in a statewide EGS collaborative (April 2020-June 2021), linking clinical registry data to quarterly consumer credit reports from 1 year before through 1 year after admission. The primary outcome was any increase in medical debt in collections from admission to 12 months; the secondary outcome was debt magnitude among affected patients. Modified Poisson and negative binomial regression evaluated incidence and magnitude, respectively.
RESULTS: Overall, 382 patients (9.1%) had increased medical debt in collections (mean increase $1,764; median $535). Estimated income demonstrated a dose-response relationship (15.2% <$40,000 vs 2.7% >$100,000; aRR 5.67, 95% CI 3.69-8.69). Uninsured patients had 4.06-fold higher risk than privately insured patients (95% CI 2.82-5.84; adjusted probability 29.5% vs 7.3%). Operative intervention, intensive care, and hospital length of stay were not associated with increased debt.
CONCLUSIONS: Nearly 1 in 10 patients had increased medical debt in collections after EGS. Associations with income and insurance, but not treatment intensity, identify financial risk protection rather than changes in clinical care as a target for reducing post-EGS financial hardship.
STUDY DESIGN: We evaluated 4,216 adults admitted for appendicitis, gallbladder disease, small bowel obstruction, or emergency laparotomy in a statewide EGS collaborative (April 2020-June 2021), linking clinical registry data to quarterly consumer credit reports from 1 year before through 1 year after admission. The primary outcome was any increase in medical debt in collections from admission to 12 months; the secondary outcome was debt magnitude among affected patients. Modified Poisson and negative binomial regression evaluated incidence and magnitude, respectively.
RESULTS: Overall, 382 patients (9.1%) had increased medical debt in collections (mean increase $1,764; median $535). Estimated income demonstrated a dose-response relationship (15.2% <$40,000 vs 2.7% >$100,000; aRR 5.67, 95% CI 3.69-8.69). Uninsured patients had 4.06-fold higher risk than privately insured patients (95% CI 2.82-5.84; adjusted probability 29.5% vs 7.3%). Operative intervention, intensive care, and hospital length of stay were not associated with increased debt.
CONCLUSIONS: Nearly 1 in 10 patients had increased medical debt in collections after EGS. Associations with income and insurance, but not treatment intensity, identify financial risk protection rather than changes in clinical care as a target for reducing post-EGS financial hardship.