How Is Healthcare Resource Utilization Measured in Spine Surgery? A Systematic Review

Introduction: The widespread availability of healthcare data allows for the investigation into healthcare resource utilization (HCRU) as a measure of health outcomes. The current literature, however, lacks a standardized approach to reporting and measuring healthcare utilization, especially within spine surgery. The aim of this study was to characterize the metrics used to report HCRU for spine surgery patients in the United States.

Methods: A comprehensive literature search was conducted under PRISMA guidelines of Embase, Scopus, and PubMed. Specific search methods used key terms to identify studies related to healthcare resource utilization in spine surgery. Studies were excluded if the patient population was pediatric, not in the United States, or if patients received surgery for spine trauma, infection, or malignancy.

Results: There were 65 studies included in the final analysis with a total of 941,231 patients. By spinal level, 328,217 (37.41%) patients underwent cervical surgery, 20,603 (2.35%) underwent thoracic surgery, and 528,534 (60.24%) underwent lumbar surgery. A total of 24 HCRU metrics were reported across all studies. The top 5 metrics were: Length of Stay (37/65), Medical Costs (33/65), Medications (28/65), Outpatient Visits (26/65), ED Visits (26/65). Unique HCRU metrics used in < 5 studies were: Home Health Services (4/65), Lab Services (4/65), Urgent Care Visits (4/65), Referrals (4/65), Nursing Care (3/65), Length of Stay for Future Hospitalizations (2/65), EMR Messages (2/65), Patient Workdays Lost (1/65), Family Member Workdays Lost (1/65), and Insurance Claims (1/65).

Conclusion : Based on this review, the current literature lacks a uniform and comprehensive approach to reporting HCRU in spine surgery. This highlights the need for a standardized approach to describing HCRU in order to better correlate this information with health outcomes.