Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 13;6(6):638-644.
doi: 10.22603/ssrr.2022-0030. eCollection 2022 Nov 27.

Predictive Analysis of Healthcare Resource Utilization after Elective Spine Surgery

Erik B Gerlach  1 , Felipe Ituarte  1 , Mark A Plantz  1 , Peter R Swiatek  1 , Nicholas A Arpey  1 , Jeremy S Marx  1 , David J Fei-Zhang  1 , Srikanth N Divi  1 , Wellington K Hsu  1 , Alpesh A Patel  1
Affiliations

Predictive Analysis of Healthcare Resource Utilization after Elective Spine Surgery

Erik B Gerlach et al. Spine Surg Relat Res. .

Abstract

Introduction: The management of degenerative spine pathology continues to be a significant source of costs to the US healthcare system. Besides surgery, utilization of healthcare resources after spine surgery drives costs. The responsibility of managing costs is gradually shifting to patients and providers. Patient-centered predictors of healthcare utilization after elective spine surgery may identify targets for cost reduction and value creation. Therefore, our study aims to quantify patterns of healthcare utilization and identify risk factors that predict high healthcare utilization after elective spine surgery.

Methods: A total of 623 patients who underwent elective spine surgery at a tertiary academic medical center by one of three fellowship-trained orthopedic spine surgeons between 2013 and 2018 were identified in this retrospective cohort study. Healthcare utilization was quantified including advanced spine imaging, emergency and urgent care visits, hospital readmission, reoperation, PT/OT referrals, opioid prescriptions, epidural steroid injections, and pain management referrals. Patient variables, namely, the Charlson comorbidity index (CCI) and the American Society of Anesthesiologists (ASA) classification system, were assessed as potential predictors for healthcare utilization.

Results: Among all patients, a wide range of health utilization was identified. Age, body mass index, Charlson Comorbidity Index, and American Society of Anesthesiology class were identified as positive predictors of postoperative healthcare utilization including emergency department visits, spine imaging studies, opioid and nerve blocker prescriptions, inpatient rehabilitation, any referrals, and pain management referrals.

Conclusions: Markers of patient health-such as CCI and ASA class-may be used to predict healthcare utilization following elective spine surgery. Identifying at-risk patients and addressing these challenges prior to surgery is an important step to deliver efficient postoperative care.

Level of evidence: 3.

Keywords: Spine surgery; cost; economic; quality; utilization.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

References

    1. Devin CJ, Chotai S, Parker SL, et al. A cost-utility analysis of lumbar decompression with and without fusion for degenerative spine disease in the elderly. Neurosurgery. 2015;77(suppl_1):S116-24. - PubMed
    1. Jansson K-Å, Nemeth G, Granath F, et al. Health-related quality of life (EQ-5D) before and one year after surgery for lumbar spinal stenosis. J Bone Joint Surg Br. 2009;91(2):210-6. - PubMed
    1. Weiss AJ, Elixhauser A, Andrews RM. Characteristics of operating room procedures in US hospitals, 2011: statistical brief# 170. 2014. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006. - PubMed
    1. Martin BI, Mirza SK, Spina N, et al. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine. 2019;44(5):369-76. - PubMed
    1. Indrakanti SS, Weber MH, Takemoto SK, et al. Value-based care in the management of spinal disorders: a systematic review of cost-utility analysis. Clin Orthop Relat Res. 2012;470(4):1106-23. - PMC - PubMed

LinkOut - more resources