Patient education and new technologies can help reduce unnecessary and costly patient interactions post lumbar surgery

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Jeffrey Gum

In an effort to reduce unnecessary patient interactions and associated costs following lumbar surgery, providers should utilise virtual visits or new technologies to monitor patient’s postoperative progress, a new study has suggested.  

Published in The Spine Journal, by Neda Gilmartin and Jeffrey Gum (Norton Leatherman Spine Center, Louisville, USA) et al, the study found that 40% of patients undergoing lumbar surgery had a healthcare encounter outside their routine follow up that did not result in an additional intervention after their index operation.

Gum et al note that such potentially unnecessary encounters create additional cost and inconvenience to both the patient and healthcare system. They explain that providing patient reassurance is “important” and that providers “should identify ways to reduce associated costs through patient education” as well.

The retrospective study included 200 patients who underwent lumbar fusions from 2018–2019 from a multi-surgeon single tertiary spine centre.

All non-routine healthcare encounters, such as phone calls, office and emergency department visits, and additional testing were collected. Direct costs for all healthcare services were determined using the Medicare Allowable rates. Indirect costs were determined using local, median income, length of office visits, and distance from the clinic to the patient’s home.

Of 200 patients, 14 with thoracic fusion were excluded. The mean age of the 186 included patients was 58.26 years and 85 (46%) were male.

A total of 47% (87/186) had only routine postoperative visits and 24 had revision surgery. Seventy-five patients made a total of 102 phone calls, 55 office visits, leading to 38 diagnostic studies none of which led to an additional intervention.

Using Medicare Allowable rates, the mean direct cost was US$776 per patient and using a median income of $16/hour the mean indirect cost was $124 per patient.

There were no differences in the baseline characteristics among the patients who only had routine post-op encounters, had non-routine encounters or had a repeat surgery.

Speaking to Spinal News International, Gum said: “It is important to critically understand areas of waste in all areas of medical care but more so in high cost areas such as lumbar spinal fusions.  Undoubtedly, the volume and cost of lumbar fusions are increasing which, in return and rightfully so, increases scrutiny.  Typically, the 90-day postoperative interval falls within a global payment period which is covered or bundled with the initial episode of care cost.

“Unnecessary visits to the hospital or office have the potential to not be reimbursed by payors if within this postoperative period.  Several studies have questioned the usefulness of routine postoperative visits, radiographs, and additional diagnostic testing in the absence of valid complaints.

“Our goal was to perform a granular analysis of these interactions and determine the incremental value, if any.  As suspected, there appears to be a significant amount of waste which presents opportunity for improvement in these care pathways.  The balance of reducing unnecessary resource utilisation and maintaining patient satisfaction in this interval is delicate but has room for improvement.

“Although beyond the scope of this project, we feel that new technologies such as wearables, smart implants, or improved tracking devices will afford an opportunity to optimise the balance between keeping the patient happy and minimising waste.”


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