JMIR Publications

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:

To determine the rates of 90-day 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 utilize 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 application. 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 (U) and non-users (N) had similar demographics: the average ages were 57.9±12.5 (U) and 61.5±12.7 (N); 54.1% (U) and 47.3% (N) were male; 90.1% (U) and 88.7% (N) had commercial or Medicare insurance. Cervical fusions (55.1%) and single-approach lumbar fusions (22.8%) were the most common procedures for all patients. Patients who used MMS had a lower 90-day readmission rate (8.1%, n=55) than those who did not (8.9%, n=30). Mild complications (n=56, 8.3% vs. n=32, 9.5%) and severe complications (n=66, 9.7% vs. n=43, 12.8%) were also lower in MMS patients. MMS users had a lower 90-day ER visit rate (9.1% (n=62) vs. 13.4% (n=45)). After adjusting for patient age and sex, the odds of having 90-day ER visits for MMS users was 32% lower than non-users (odds ratio: 0.68, 95% CI [0.45, 1.02], P=0.06).

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 post-surgical ER visits in a large group of spine surgery patients. A planned randomized controlled trial will provide additional evidence that this digital health tool can be used as an intervention to improve patient outcomes.