Outcomes With a Mobile Digital Health Platform for Patients Undergoing Spine Surgery: Retrospective Analysis

Abstract

Background Digital health solutions have been shown to enhance outcomes for individuals with chronic medical illnesses, but few have been validated for surgical patients. The digital health platform ManageMySurgery (MMS) has been validated for spine surgery as a feasible method for patients along their surgical journey through in-app education and completion of patient-reported outcomes surveys. Objective The aim of this study is to determine the rates of 90-day emergency room (ER) visits, readmissions, and complications in patients undergoing spine surgery using MMS compared to patients using traditional perioperative care alone. Methods Patients undergoing spine surgery at a US-based academic hospital were invited to use MMS perioperatively between December 2017 and September 2021. All patients received standard perioperative care and were classified as MMS users if they logged into the app. Demographic information and 90-day outcomes were acquired via electronic health record review. The odds ratios of having 90-day ER visits, readmissions, mild complications, and severe complications between the MMS and non-MMS groups were estimated using logistic regression models. Results A total of 1015 patients were invited, with 679 using MMS. MMS users and nonusers had similar demographics: the average ages were 57.9 (SD 12.5) years and 61.5 (SD 12.7) years, 54.1% (367/679) and 47.3% (159/336) were male, and 90.1% (612/679) and 88.7% (298/336) had commercial or Medicare insurance, respectively. Cervical fusions (559/1015, 55.07%) and single-approach lumbar fusions (231/1015, 22.76%) were the most common procedures for all patients. MMS users had a lower 90-day readmission rate (55/679, 8.1%) than did nonusers (30/336, 8.9%). Mild complications (MMS: 56/679, 8.3%; non-MMS: 32/336, 9.5%) and severe complications (MMS: 66/679, 9.7%; non-MMS: 43/336, 12.8%) were also lower in MMS users. MMS users had a lower 90-day ER visit rate (MMS: 62/679, 9.1%; non-MMS: 45/336, 13.4%). After adjustments were made for age and sex, the odds of having 90-day ER visits for MMS users were 32% lower than those for nonusers, but this difference was not statistically significant (odds ratio 0.68, 95% CI 0.45-1.02; P=.06). Conclusions This is one of the first studies to show differences in acute outcomes for people undergoing spine surgery who use a digital health app. This study found a correlation between MMS use and fewer postsurgical ER visits in a large group of spine surgery patients. A planned randomized controlled trial will provide additional evidence of whether this digital health tool can be used as an intervention to improve patient outcomes.

Benefits, Recruitment, Dropout, and Acceptability of the Strength Back Digital Health Intervention for Patients Undergoing Spinal Surgery: Nonrandomized, Qualitative, and Quantitative Pilot Feasibility Study

“…A large proportion of the approached patients wanted to participate in the study, and once they started with the intervention, almost all participants used it until the posttest assessment and final interview. The willingness to use a digital health intervention seemed quite high in our study compared with in previous studies [ 67 , 68 ]. It seems that, once participants started the intervention in this study, they saw its value and kept using it over a longer period.…”

Digital Health Platforms for Breast Cancer Care: A Scoping Review

“…The oncologic literature suggests patients who routinely report symptoms through digital health platforms have a lower symptom burden due to the increased awareness of serious adverse reactions and earlier detection by patients and providers [48]. Furthermore, by providing education to patients, expectations are more easily managed, and there is a reduction in patient visits to emergency departments [49].…”

Pushing the Limits of Minimally Invasive Spine Surgery—From Preoperative to Intraoperative to Postoperative Management

“…Through this application, the research team was able to collect patient-reported outcome measures, offer self-monitoring features, answer frequently asked questions, and provide educational materials on the patient's surgery [91]. In a larger follow-up study of over 1000 patients, Venkatraman et al found that spine surgery patients making use of this app experienced fewer 90-day readmissions and were 32% less likely to visit the emergency room within 90 days following their surgery [6]. Although these tools are cost-effective means to provide patients with information and collect data, it is important that patients are not overly reliant on such technology and delay presentation for a concerning postoperative development.…”

“…Improvements in perioperative care have mirrored advances within the operating room, and helped optimize patient selection, management of comorbid conditions, and return to baseline functional status following surgery. Measures ranging from enhanced recovery after surgery (ERAS) protocols to digital health solutions, like smart phone applications and wearable medical devices, reflect an increasing emphasis on the postoperative management of patients undergoing minimally invasive spine surgery [5,6].…”