title: Surgical follow-up costs disproportionately impact low-income patients.
abstract: BACKGROUND
  Surgical procedures have significant costs at the national level, but the financial burden on patients is equally important. Patients' out-of-pocket costs for surgery and surgical care include not only direct medical costs but also the indirect cost of lost wages and direct nonmedical costs including transportation and childcare. We hypothesized that the nonmedical costs of routine postoperative clinic visits disproportionately impact low-income patients.
  
  
  METHODS
  This was a cross-sectional study performed in the postoperative acute care surgery clinic at a large, urban county hospital. A survey containing items about social, demographic, and financial data was collected from ambulatory patients. Nonmedical costs were calculated as the sum of transportation, childcare, and lost wages. Costs and cost to income ratios were compared between income strata.
  
  
  RESULTS
  Ninety-seven patients responded to the survey of which 59 reported all items needed for cost calculations. The median calculated cost of a clinic visit was $27 (interquartile range $18-59). Components of this cost were $16 ($14-$20) for travel, $22 ($17-$50) for childcare among patients requiring childcare, and $0 ($0-$30) in lost wages. Low-income patients had significantly higher (P = 0.0001) calculated cost to income ratios, spending nearly 10% of their monthly income on these costs.
  
  
  CONCLUSIONS
  The financial burden of routine postoperative clinic visits is significant. Consistent with our hypothesis, the lowest income patients are disproportionately impacted, spending nearly 10% of their monthly income on costs associated with the clinic visit. Future cost-containment efforts should examine alternative, lower cost methods of follow-up, which reduce financial burden.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, Texas. Electronic address: ascott@bcm.edu.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Scott
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Augustus J
authors.initials: AJ
authors.lastname: Rush
authors.affiliation: Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, Texas; Alkek Department of Medicine, Baylor College of Medicine, Houston, Texas; Medical and Extended Care Lines, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, Texas; Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, Texas; Department of Surgery, Ben Taub General Hospital, Houston, Texas.
authors.forename: James W
authors.initials: JW
authors.lastname: Suliburk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002654:Child Care / Q000191:economics*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000191:economics*; D011203:Poverty; D013781:Texas; D014186:Transportation / Q000191:economics*
keywords: Healthcare disparities; Postoperative care; Surgical cost; Surgical follow-up; Surgical value