151. Financial Toxicity Negatively Impacts Outcomes in Lower Extremity Trauma Patients

PURPOSE: Financial toxicity (FT) describes the adverse economic effects of medical expenses. It is associated with poorer health-related quality of life and worse psychological and clinical outcomes, including increased mortality, and it persists for years after diagnosis or injury. Little is known about how FT affects trauma patients. Therefore, we aimed to evaluate risk factors for the presence and persistence of FT in lower extremity trauma patients requiring soft tissue reconstruction. METHODS: We conducted a cross-sectional study of patients who sustained traumatic lower extremity injuries distal to the mid-femur. We collected demographic and clinical data. Our primary outcome was the Financial Burden score from the LIMB-Q, a patient-reported outcome measure designed for and validated in patients with lower extremity trauma. Scores range from 0-100, with lower scores indicating worse FT. We performed descriptive statistics and used multivariable linear regression to identify independent predictors of FT. RESULTS: We collected data from 301 patients with a mean age of 42 years (SD 16). Most respondents were male (64%), US residents (71%), and White (65%), with less than a college degree (56%). Annual income was <$30,000 for 29% of respondents. Median time from injury was 2 years (IQR 1-4 years). About half (56%) underwent fracture fixation only, but 28% required soft tissue reconstruction, and 16% underwent amputation. The mean LIMB-Q Financial Burden score was 56 (SD 20). Black race, lower education level, and lower income were associated with worse FT (p<0.05). Patients requiring soft tissue reconstruction had worse FT compared to those requiring fracture fixation only, but less FT compared to those requiring amputation (p<0.05). Less FT was associated with better outcomes on LIMB-Q’s Symptoms (p<0.01) and Psychological (p<0.05) scales. Financial toxicity did not change with increasing time from injury (p>0.05). CONCLUSION: Lower extremity trauma, especially when injuries require soft tissue reconstruction or amputation, is associated with high levels of FT. Patients who are Black, lower-income, and have lower educational attainment are at greater risk of FT. Worse FT is associated with worse post-treatment symptoms and psychological well-being. Financial toxicity persists for years after lower extremity injury and negatively impacts clinical and psychological outcomes in patients with lower extremity trauma.