Electronic Communication Patterns Could Reflect Preoperative Anxiety and Serve as an Early Complication Warning in Elective Spine Surgery Patients with Affective Disorders: A Retrospective Analysis of a Cohort of 1199 Elective Spine Patients

Utility of Postoperative Phone Calls in Reducing Unplanned Health Care Utilization

INTRODUCTION

Postoperative phone calls ideally proactively identify concerns. This study aimed to determine whether postoperative phone calls after elective outpatient pediatric urology surgery were associated with differences in postoperative healthcare utilization.

METHODS

This retrospective cross-sectional study included patients undergoing elective outpatient pediatric urologic surgery in selected months of 2019-2021. Data were abstracted on patient demographics, postoperative call completion, number and timing of parent-initiated calls within 30 d, concerns for parent-initiated calls, and timing and indication for emergency department visits within 30 d. Patients with and without completed postoperative calls were compared.

RESULTS

Of 1494 patients, 416 (38.6%) had completed postoperative phone calls; 1078 (61.4%) did not. Calls were more likely to be completed in more disadvantaged areas (Area Deprivation Index deciles 9-10; odds ratio [OR] = 3.87, 95% confidence interval [CI]: 2.70-5.54, P < 0.0001). Overall, the proportions of patients seeking emergency care within 30 d (3.6% versus 4.0%, OR = 0.90, 95% CI: 0.49-1.64, P = 0.73) and with parent-initiated phone calls (31.7% versus 31.3%, OR = 1.02, 95% CI: 0.80-1.20, P = 0.86) were similar in patients with and without postop calls completed. For children in less disadvantaged areas (Area Deprivation Index decile 1-2), the likelihood of a parent-initiated call was higher when postop calls were completed (47.8% versus 33.6%, OR = 1.79, 95% CI: 1.15-2.79, P = 0.01).

CONCLUSIONS

Routine postoperative phone calls within 72 h of outpatient pediatric urologic surgery are not associated with decreased overall postoperative health care utilization, and in some cases are associated with an increase in calls to clinic. Defining patient and provider expectations for postoperative contact may make postoperative calls more useful.

Factors associated with greater patient satisfaction in outpatient neurosurgical clinics: Recommendation for surgery, older age, cranial chief complaint, and public health insurance

OBJECTIVE

Patient satisfaction has increasingly played a role in determining care quality. Surveys are used to gauge patient experience, satisfaction of care, and likelihood to recommend providers and facilities. The aim of the study is to evaluate whether clinical and demographic data predict greater patient satisfaction with providers in the outpatient neurosurgery clinic.

METHODS

Press-Ganey (Press Ganey Associates, South Bend, IL) evaluations of 1521 patients were reviewed in an academic neurosurgical clinic from January 1, 2019 through February 1, 2021. We analyzed associations between Press-Ganey ratings and patient demographics, chief complaint, psychiatric comorbidities, number of orders placed, medication prescriptions, surgical recommendation, payor status, and referral source. We used univariate logistic regression to assess for associations between independent variables and Press-Ganey ratings. Multivariable logistic regression was used for associated factors.

RESULTS

For the Likelihood to Recommend question, older age (p = 0.003), cranial chief complaint (p = 0.046), and recommendations for surgery (p < 0.001) were significantly associated with "good" ratings. For the rating of Care Received, older age (p = 0.002), cranial chief complaint (p = 0.05), and recommendations for surgery (p = 0.002) were significantly associated with "good" ratings. For Confidence in Care Provider question, recommendations for surgery (p = <0.001) and government insurance type (p = 0.002) were significantly associated with "good" ratings.

CONCLUSIONS

Patients with older age, cranial pathologies, a recommendation for surgery, and government health insurance were significantly associated with favorable patient satisfaction with providers in the outpatient neurosurgery clinic. Prospective studies should target patient populations who are younger, have spinal complaints, have non-surgical needs, and have commercial insurance to improve satisfaction.

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) Comparison Study: Assessing for PROMIS-29 Depression and Anxiety Psychopathologic Cutoff Values Amongst Patients Undergoing Elective Complex Spine Procedures

OBJECTIVE

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and the Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) are used to assess patient psychology, pain, and quality of life. As psychological factors, such as depression and anxiety, are associated with poor perioperative outcomes, we aim to translate MMPI-2-RF values to PROMIS-29 scores and establish cutoff values for PROMIS-29 anxiety and depression domains that might warrant attention preoperatively.

METHODS

Seventy adult patients scheduled for an elective spinal surgery between July 2018 and February 2020 who completed both the MMPI-2-RF and PROMIS-29 preoperatively at a single institution were reviewed.

RESULTS

Patients with MMPI-2-RF scores of 65 or greater (the cutoff for psychopathology) in the emotional/internalizing dysfunction scale (4.29%) had an average PROMIS-29 depression score of 14.33, which is significantly higher than the control group's (<65 score) 8.49 score (P = 0.04). Similarly, those demonstrating psychopathology on the demoralization (4.29%) and helplessness/hopelessness (4.29%) scales had average PROMIS-29 depression scores significantly higher than the control group's averages (15.33 vs. 8.45, P = 0.02 and 14.33 vs. 8.49, P = 0.04, respectively). Patients with an MMPI-2-RF score of 65 or greater on the emotional/internalizing dysfunction (4.29%), stress/worry (10.00%), and anxiety (7.14%) scales had average PROMIS-29 anxiety domain scores of 15, 15, and 15, respectively, which were significantly greater than that of the control group's scores (8.94, P = 0.04; 8.75, P = 0.004; and 8.55, P < 0.001, respectively).

CONCLUSIONS

PROMIS-29 scores of 15 or greater on the depression and anxiety domains may have psychopathologies that warrant addressing, given their increased likelihood of having poor outcomes.

Impact of Insurance Provider on Postoperative Hospital Length of Stay After Spine Surgery

OBJECTIVE

Differences in insurer and payer status have been shown to increase patient hospital length of stay (LOS) by delaying the approval of transfer to a rehabilitation facility. The aim of the current study is to determine the impact of the type of insurance provider on postoperative hospital LOS after spine surgery.

METHODS

In our single-institution retrospective study, all patients undergoing elective spine surgery between August 2018 and August 2019 as part of an enhanced recovery after surgery (ERAS) protocol were enrolled in a prospectively collected registry. Insurance payer type was analyzed to determine its effect on total patient LOS after surgery.

RESULTS

A total of 106 patients were included in the study. Insurance payers studied were Medicare, private insurers (preferred provider organization and health maintenance organization), and the Veterans Affairs payer TriWest. Patients in all groups had comparable demographic characteristics and procedural variables. There was a statistically significant difference in days stayed beyond medical clearance among the 3 insurance provider groups (P < 0.001); TriWest patients stayed an average of 3.2 days beyond clearance, compared with private insurance (1.2 days) and Medicare (0.3 days). Individual subanalysis of the ERAS complex pathway population mirrored these findings.

CONCLUSIONS

Hospitalization beyond medical clearance after spine surgery follows a predictable pattern regardless of ERAS pathway complexity, with Medicare having a shorter delay in approving patient progression than private insurance, which has less of a delay than Triwest.