1082 Creation of a Spine Healthcare Resource Utilization Grouping (SHRUG) to Complement Patient-reported Outcome Measurements in Assessing Surgical Success

Abstract

INTRODUCTION: Patient-reported outcome measures (PROs) are increasingly utilized to assess surgical success. However, when taken as the sole measure of surgical success they have limitations due to the requirement of collection time and infrastructure, response bias, and inherently subjective nature. The large volume of digital data generated by modern health systems may instead offer a method to track healthcare utilization and surgical outcome. METHODS: We retrospectively reviewed a consecutive patients undergoing elective surgery to the cervical and lumbar spine for degenerative pathologies at our institution. Pre- and post-operative 12-month change in PROMIS Global Health was collected. Post-operative measures of healthcare utilization included clinic visits, inpatient encounters, telephone encounters, opioid use, physical therapy, injections, and imaging. A SHRUG metric was then constructed through latent profile analysis. RESULTS: A total of 8039 surgeries were included in our analysis. Four utilization groups were identified: 1) low utilizer group, representing 53.9% of all patients; 2) moderate utilizer group (13.2%); 3) heterogenous utilizer group (25.2%); and 4) high utilizer group (7.7%). Patients were placed into one of four groups with high average probability (97%, 92%, 95%, 93% respectively). CONCLUSIONS: Our study developed a novel method for defining surgical outcomes based on healthcare utilization. These groupings have the potential to add an objective measure of operative success to supplement the use of PROs clinically. SHRUG can approximates PROMIS, nonbiased, provides new insight on outcome and healthcare utilization, and finally clinically feasible to implement.