Oral Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

INTRODUCTION: Secure patient messaging through electronic patient portals has grown immensely over recent years. Despite its increasingly frequent utilization by patients to engage with their care team, its association with clinical outcomes remains unknown in spine surgery. We sought to investigate if there was an association between patients undergoing lumbar spine surgery who send patient messages postoperatively and unexpected hospital readmissions within 90 days of surgery.

METHODS: This retrospective study included adult patients who underwent single-stage lumbar spine surgery at a large academic institution between January 2016 and June 2023. Patients with incomplete information or those who died within 90 days of surgery were excluded. The institutional database contained 13,420 procedures, including 7,118 decompression, 5,990 decompression and fusion/instrumentation, and 312 deformity correction surgeries. Patient sociodemographic, hospital readmission, and patient-provider engagement data were collected. The mean and standard deviation were calculated for continuous variables. A multivariable logistic regression was used to estimate the effect of patient engagement and clinical covariates on the occurrence of hospital readmission. An interaction term was included for age and number of postoperative engagements, which were mean centered to allow for the improved interpretation. 

RESULTS: A total of 13,420 patients were included. The mean age was 62 years (SD: 15 years), and the average BMI was 29 kg/m^2 (SD: 6). Of these, 1,601 (12%) patients were readmitted to the hospital at least once within 90 days of surgery. 5,081 patients used the patient portal to send an average of 2.3 ± 4.7 messages after surgery. The odds ratio for post-operative engagement, age, discharge to home, and ASA scores of 3 and 4 were 1.03, 1.01, 0.57, 2.56, and 4.28 respectively. The interaction between age, ASA score, and post-operative engagement is shown in Figure 1.

DISCUSSION: Patients discharged home have a reduced risk of readmission within 90 days of surgery, while higher ASA scores increases the risk, bolstering the external validity of our findings. Postoperative engagement was overall associated with an elevated chance of readmission. Though it is commonly assumed older patients use messaging less than their younger counterparts due to technology familiarity differences, we found no age-based difference in patient engagement. Interestingly, older patients who sent messages post-surgery exhibited a slight reduction in their readmission risk, whereas younger patients demonstrated a marginal increase. This suggests that frequent younger patient engagement may indicate complications that lead to readmission. Readmission rates to the hospital is a salient metric given its use by numerous quality and safety scores. It is important for providers to focus on this patient cohort and allocate resources to both mitigate and proactively prevent readmission. Further studies with a comprehensive range of spine procedures should be conducted to validate our findings and alternative forms of communication such as phone calls should be considered.