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The Unseen Cost Of Trauma: Unemployment And Homelessness Following Plastic Surgery
Zachary J. Eisner, BS1, Nikathan Kumar, MD
2, Raunak Goyal, MBBS
3, Preet Hathi, MBBS
4, Srinivasan Vengadassalapathy, MBBS, MD
5, Shivangi Saha, MCh
4, Praveen Ganesh, MDS, FCCS, FCMFS
5, Shashank Chauhan, MCh
4, Maneesh Singhal, MCh
4, Anam Ehsan, MBBS
6, S. R. Sabapathy, MS, MCh, DNB
7, Andrea Pusic, MD, MHS, FACS, FRCSC
6, Kavitha Ranganathan, MD
8;
1University of Michigan Medical School, Ann Arbor, MI, USA,
2University of California San Francisco, San Francisco, CA, USA,
3Deen Dayal Upadhyay Hospital, New Delhi, India,
4All India Institute of Medical Sciences, New Delhi, India,
5Saveetha Medical College and Hospital Chennai, Tamil Nadu, India,
6Brigham and Women’s Hospital, Boston, MA, USA,
7Ganga Medical Centres and Hospitals, Tamil Nadu, India,
8Brigham and Women’s Hospital; Boston, Boston, MA, USA
PURPOSE: Plastic surgery trauma patients are at high risk for disability post-injury. This can affect one’s ability to work, generate income, and afford housing. The longitudinal trajectory of job security and ability to afford basic needs after trauma remains unclear. The goal of this study is to track and quantify unemployment and homelessness after plastic surgery-specific trauma.
METHODS: A prospective, multicenter cohort study was conducted including post-trauma plastic surgery inpatients across three tertiary hospitals. Patients were surveyed for sociodemographics, clinical outcomes, and social determinants of health at 1-, 3- and 6-months post-operatively. The primary outcome was new unemployment or homelessness postoperatively, with multivariate logistic regression utilized to determine predictors of outcomes.
RESULTS: Of 781 patients, 19.1%(n=149) were newly unemployed at one month, and 45.1%(n=352) by six months post-operatively. Homelessness affected 7.3%(n=57) of patients at one month, increasing to 13.6%(n=106) at six months post-operatively (
Figure 1). New unemployment was most strongly associated with ICU admission(OR=1.39[1.18,1.63], p<0.001), increased injury severity(OR=1.21[1.09,1.35],p<0.001), and no insurance(OR=1.27[1.12,1.44],p<0.001). New homelessness was most strongly associated with increased injury severity(OR=1.15[1.06,1.25],p<0.001), larger hospital bills(OR=1.10[1.05,1.13],p<0.001), and decreased household income(OR=1.11[1.08,1.16],p<0.001).
CONCLUSION: Unemployment and homelessness increase steadily over six months for plastic surgery trauma patients. Identifying high-risk patients presenting with disability from greater injury severity, and at risk for financial toxicity postoperatively is imperative. Tailored, injury-specific social rehabilitation services are required to prevent these adverse outcomes.
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