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STUDY DESIGN: Retrospective study. OBJECTIVE: To explore the association between patients undergoing lumbar spine surgery who message their care team via an electronic patient portal (EPP) post-operatively and emergency department (ED) visits within 90 days of surgery. SUMMARY OF BACKGROUND DATA: Secure patient messaging through electronic patient portals has grown over recent years. Despite its frequent utilization by patients to engage with their care team, its association with clinical outcomes remains unknown in spine surgery. METHODS: This study was approved by our Institutional Review Board. Inclusion criteria were adults who underwent single-stage lumbar spine surgery between January 2016-June 2023. Patients with incomplete information, multi-stage surgeries, and those who died within 90 days of surgery were excluded. Patient sociodemographic, surgical, hospital readmission, and patient-provider engagement data were collected. RESULTS: A total of 13,135 patients were included. A total of 1,711 patients (13%) had a post-operative ED visit, and 4,791 patients (36%) used the patient portal to send a message after surgery. Sending a post-operative patient message after undergoing lumbar spine surgery was associated with an increased likelihood of having an ED visit that does not lead to readmission (1.29 (1.10-1.53), P = 0.002). Patients with high school degrees were more likely to have an ED visit without readmission (1.33 (1.08-1.65), P = 0.008). CONCLUSION: Patients at a higher risk of presenting to the ED post-operatively should be identified and may benefit from additional counseling and access to the care team virtually to limit unnecessary healthcare utilization. Focusing on patients who reach out via EPP messaging post-operatively may be a good target patient group to address first. Future research is needed to investigate the possible health literacy and other socioeconomic barriers affecting these patients so that appropriate, more cost-effective resources can be utilized to avoid clinically unnecessary and costly ED visits.
RESUMO
Introduction: Various methods are used for open reduction and internal fixation of Lisfranc injuries, and each shows different post-treatment outcomes. Other than the common post-surgery problems in these patients, including possible non-anatomical reduction, implant loosening, breakage, and arthritis, most of these patients will undergo a second surgery for implant removal which itself might cause further complications. To reduce the need for re-operation, bio-degradable or bio-integrative implants can be promising; however, the short- and long-term outcomes have been scarcely investigated to date. Case Report: We followed up 10 adult patients who received bio-integrative screws for Lisfranc injuries. The patients were asked to fill out the patient-reported outcome measures (PROMs) surveys during one of the follow-up visits. We gathered variables including the type of injury, pain score, and PROMs including physical function (PF), pain interference, pain intensity, and depression. We evaluated the patients for wound dehiscence, non-union, and hardware failure. The median (interquartile range [IQR]) follow-up time of the patients in this study was 9 (4-11.5) months. Nine out of 10 patients with Lisfranc injuries who received bio-integrative screws showed improvements in their pain scores and started progressive weight-bearing. Among 3 patients who had sport-related Lisfranc injuries, 2 returned to play in <6 months, and one started side-to-side agility work in <3 months. The median (IQR) scores of PROMs representing PF, depression, physical health, mental health, pain interference, and pain intensity were 49.5 (30.1-61.9), 41 (41-49), 50.8 (39.2-57.7), 59 (48.9-63.7), 51.7 (41.6-72.6), and 43.5 (37.8-55.2), respectively. Conclusion: Our results demonstrated promising short-term outcomes of using bio-integrative screws in patients with Lisfranc injuries based on PROMs and the rate of complications. Future studies on larger populations and more comprehensive variables with longer follow-up duration should be the next step in evaluating the pros and cons of these new implants.
