Investigating the Impact of Home Care Services after Lumbar Fusion on Readmission, Reoperation, and Patient Reported Outcomes.

Abstract

Study design: Retrospective cohort.

Objective: Investigate how home care (HC) services impact utilization of postoperative resources and outcomes after lumbar fusion.

Summary of background data: Utilization of spinal fusion has increased over the past decade-it has become important to coordinate postoperative discharge that maximizes rehabilitation and cost-effectiveness.

Methods: Bundled payment information of lumbar fusion episodes of care from a private payer (2019-2021) was reviewed to identify patients. Manual chart review was conducted to evaluate demographic/surgical details, complications, and readmissions. Insurance claims data was reviewed to identify HC utilization after discharge-disposition was designated as home with HC versus no HC.

Results: 758 patients were included (13.6% HC, 86.4% no HC). Patients with HC were older (68.6±9.76 vs. 59.5±11.2;P<0.001), had higher BMI (31.1±6.17 vs. 30±5.9;P<0.001), and CCI (1.07±1.24 vs. 0.59±0.91;P=0.002), and longer operative time (211±86.7 vs.178±78.9;P<0.001). HC was associated with 90-day reoperation (13.6% vs. 1.07%;P<0.001), and readmission (30-day:7.77% vs. 1.98%;90-day:12.6% vs. 3.51%;P<0.001). HC was associated with reoperation for compressive fluid/dural repair (2.91% vs. 0.31%), and wound complication/infections (3.88% vs. 0%), and with medical readmissions (4.85% vs. 1.53%;P<0.001). On multivariate analysis, HC was an independent predictor of further healthcare utilization-office visits (incidence rate ratio (IRR):1.14;P=0.049), phone calls (IRR:1.38;P=0.02), and ED visits (IRR:6.5;P<0.001). Despite similar preoperative physical function scores (SF-12 PCS), HC was associated with worse 6-month (P<0.001) and 1-year scores (P=0.05).

Conclusion: Patients receiving HC were older, sicker, and had longer surgeries. Patients with HC experienced more readmissions and reoperations particularly for wound and medical issues. HC independently predicted further postoperative healthcare utilization via office calls/visits and ED visits. These findings suggest that patients requiring HC are a particularly vulnerable population and that HC does not exert a protective effect against additional healthcare utilization. Further research is needed to identify proactive interventions that can decrease cost and improve outcomes.