Using Resource Utilization in Spine Healthcare to Complement Patient-Reported Outcome Measurements in Assessing Surgical Success

Abstract

ObjectivePatient-reported outcome measures (PROMs) are utilized to assess surgical success but are limited by data collection, response bias, and subjectivity. The large volume of digital healthcare data offers a new method to utilize healthcare utilization as a longitudinal, individualized, and objective proxy for health needs among surgical patients. This study aimed to design and evaluate a novel resource utilization in spine healthcare (RUSH) clustering method that complements PROMs in evaluating post-operative patient outcomes. MethodsThis retrospective cross-sectional study conducted at a large, tertiary healthcare system included all adult patients undergoing cervical or lumbar surgery between 2014 to 2020 with at least 3 months follow-up. Post-operative healthcare utilization was analyzed using clinic visits, inpatient encounters, telephone encounters, MyChart messages, opioid use, physical therapy, injections, and imaging. Latent profile analysis determined RUSH clusters and changes in PROM Information System Physical Health (PROMIS-PH) scores pre- and 12-months post-operation. ResultsThis study included 5,602 surgeries (mean age 61.3 ± 13.1, 49.9% female). Four RUSH groups were identified: low utilizers (21.5%), moderate utilizers without advanced imaging (34.7%), moderate utilizers with advanced imaging (10.7%), and high utilizers (33.1%,). Utilization patterns varied by surgery type, with lower-utilization patterns among non-fusion procedures and a consistent sub-population of high utilizers across all surgery types. High RUSH utilizers had the lowest pre-operative PROMIS-PH scores and the worst average postoperative change. ConclusionsRUSH clustering provides a novel, data-driven approach to measure surgical success, complementing traditional PROMs, and leveraging big data to monitor and respond to surgical outcomes.