Venkatraman Vishal, Kirsch Elayna P, Luo Emily, Kunte Sameer, Ponder Madison, Gellad Ziad F, Liu Beiyu, Lee Hui-Jie, Jung Sin-Ho, Haglund Michael M, Lad Shivanand P
Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States.
Higgs Boson Health, Durham, NC, United States.
JMIR Perioper Med. 2022 Oct 26;5(1):e38690. doi: 10.2196/38690.
Digital health solutions have been shown to enhance outcomes for individuals with chronic medical illnesses, but few have been validated for surgical patients. The digital health platform ManageMySurgery (MMS) has been validated for spine surgery as a feasible method for patients along their surgical journey through in-app education and completion of patient-reported outcomes surveys.
The aim of this study is to determine the rates of 90-day emergency room (ER) visits, readmissions, and complications in patients undergoing spine surgery using MMS compared to patients using traditional perioperative care alone.
Patients undergoing spine surgery at a US-based academic hospital were invited to use MMS perioperatively between December 2017 and September 2021. All patients received standard perioperative care and were classified as MMS users if they logged into the app. Demographic information and 90-day outcomes were acquired via electronic health record review. The odds ratios of having 90-day ER visits, readmissions, mild complications, and severe complications between the MMS and non-MMS groups were estimated using logistic regression models.
A total of 1015 patients were invited, with 679 using MMS. MMS users and nonusers had similar demographics: the average ages were 57.9 (SD 12.5) years and 61.5 (SD 12.7) years, 54.1% (367/679) and 47.3% (159/336) were male, and 90.1% (612/679) and 88.7% (298/336) had commercial or Medicare insurance, respectively. Cervical fusions (559/1015, 55.07%) and single-approach lumbar fusions (231/1015, 22.76%) were the most common procedures for all patients. MMS users had a lower 90-day readmission rate (55/679, 8.1%) than did nonusers (30/336, 8.9%). Mild complications (MMS: 56/679, 8.3%; non-MMS: 32/336, 9.5%) and severe complications (MMS: 66/679, 9.7%; non-MMS: 43/336, 12.8%) were also lower in MMS users. MMS users had a lower 90-day ER visit rate (MMS: 62/679, 9.1%; non-MMS: 45/336, 13.4%). After adjustments were made for age and sex, the odds of having 90-day ER visits for MMS users were 32% lower than those for nonusers, but this difference was not statistically significant (odds ratio 0.68, 95% CI 0.45-1.02; P=.06).
This is one of the first studies to show differences in acute outcomes for people undergoing spine surgery who use a digital health app. This study found a correlation between MMS use and fewer postsurgical ER visits in a large group of spine surgery patients. A planned randomized controlled trial will provide additional evidence of whether this digital health tool can be used as an intervention to improve patient outcomes.
数字健康解决方案已被证明可改善慢性疾病患者的治疗效果，但很少有方案在外科手术患者中得到验证。数字健康平台ManageMySurgery（MMS）已被验证可用于脊柱手术，是一种可行的方法，可让患者在整个手术过程中通过应用内教育和完成患者报告结局调查受益。
本研究的目的是确定与仅接受传统围手术期护理的患者相比，使用MMS进行脊柱手术的患者90天急诊室就诊率、再入院率和并发症发生率。
2017年12月至2021年9月期间，邀请在美国一家学术医院接受脊柱手术的患者在围手术期使用MMS。所有患者均接受标准围手术期护理，若登录该应用程序则被归类为MMS用户。通过电子健康记录审查获取人口统计学信息和90天结局。使用逻辑回归模型估计MMS组和非MMS组之间90天急诊室就诊、再入院、轻度并发症和严重并发症的比值比。
共邀请了1015名患者，其中679名使用MMS。MMS用户和非用户的人口统计学特征相似：平均年龄分别为57.9（标准差12.5）岁和61.5（标准差12.7）岁，男性分别占54.1%（367/679）和47.3%（159/336），分别有90.1%（612/679）和88.7%（298/336）拥有商业保险或医疗保险。颈椎融合术（559/1015，55.07%）和单入路腰椎融合术（231/1015，22.76%）是所有患者中最常见的手术方式。MMS用户的90天再入院率（55/679，8.1%）低于非用户（30/336，8.9%）。MMS用户的轻度并发症（MMS：56/679，8.3%；非MMS：32/336，9.5%）和严重并发症（MMS：66/679，9.7%；非MMS：43/336，12.8%）也较低。MMS用户的90天急诊室就诊率较低（MMS：62/679，9.1%；非MMS：45/336，13.4%）。在对年龄和性别进行调整后，MMS用户90天急诊室就诊的几率比非用户低32%，但这种差异无统计学意义（比值比0.68，95%置信区间0.45 - 1.02；P = 0.06）。
这是首批显示使用数字健康应用程序的脊柱手术患者急性结局存在差异的研究之一。本研究发现，在一大群脊柱手术患者中，使用MMS与术后急诊室就诊次数减少之间存在相关性。一项计划中的随机对照试验将提供更多证据，证明这种数字健康工具是否可作为一种干预措施来改善患者结局。
