择期脊柱手术后医疗资源利用的预测分析
Predictive Analysis of Healthcare Resource Utilization after Elective Spine Surgery.
作者信息
Gerlach Erik B, Ituarte Felipe, Plantz Mark A, Swiatek Peter R, Arpey Nicholas A, Marx Jeremy S, Fei-Zhang David J, Divi Srikanth N, Hsu Wellington K, Patel Alpesh A
机构信息
Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, USA.
出版信息
Spine Surg Relat Res. 2022 Jun 13;6(6):638-644. doi: 10.22603/ssrr.2022-0030. eCollection 2022 Nov 27.
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
引言
退行性脊柱疾病的治疗仍是美国医疗系统成本的一个重要来源。除了手术，脊柱手术后医疗资源的使用也推动了成本上升。管理成本的责任正逐渐转移到患者和医疗服务提供者身上。以患者为中心的择期脊柱手术后医疗资源利用预测因素可能有助于确定降低成本和创造价值的目标。因此，我们的研究旨在量化医疗资源利用模式，并确定预测择期脊柱手术后高医疗资源利用的风险因素。
方法
在这项回顾性队列研究中，我们确定了2013年至2018年间在一家三级学术医疗中心由三位接受过专科培训的骨科脊柱外科医生之一进行择期脊柱手术的623例患者。对医疗资源利用进行了量化，包括先进的脊柱成像、急诊和紧急护理就诊、住院再入院、再次手术、物理治疗/职业治疗转诊、阿片类药物处方、硬膜外类固醇注射和疼痛管理转诊。评估患者变量，即查尔森合并症指数（CCI）和美国麻醉医师协会（ASA）分类系统，作为医疗资源利用的潜在预测因素。
结果
在所有患者中，发现了广泛的医疗资源利用情况。年龄、体重指数、查尔森合并症指数和美国麻醉医师协会分级被确定为术后医疗资源利用的积极预测因素，包括急诊就诊、脊柱成像检查、阿片类药物和神经阻滞剂处方、住院康复、任何转诊和疼痛管理转诊。
结论
患者健康指标，如CCI和ASA分级，可用于预测择期脊柱手术后的医疗资源利用情况。识别高危患者并在手术前应对这些挑战是提供高效术后护理的重要一步。
证据级别
3级。
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