Measurement of Resource Utilization in Spine Healthcare for Elective Spine Surgery Patients: A Systematic Review.

OBJECTIVE: This study aimed to characterize the metrics used to report Resource Utilization in Spine Healthcare (RUSH) for spine surgery patients in the United States. METHODS: A systematic literature search identified studies related to resource utilization in spine surgery. Studies were excluded if the population was pediatric, outside the United States, or if patients received surgery for trauma, infection, or malignancy. RESULTS: There were 65 studies included in this analysis with a total of 941,231 patients. A total of 24 RUSH metrics were reported across all studies. The top 5 metrics were: length of stay (37/65), medical costs (33/65), medications (28/65), outpatient visits (26/65), and emergency department visits (26/65). Unique RUSH metrics used in <5 studies were: home health services (4/65), lab services (4/65), urgent care visits (4/65), referrals (4/65), nursing care (3/65), length of stay for future hospitalizations (2/65), electronic medical record messages (2/65), patient workdays lost (1/65), family member workdays lost (1/65), and insurance claims (1/65). Studies also varied in the number of metrics used as a proxy for RUSH. Across the studies, 9 used only 1 metric (14%), and 10 used only 2 metrics (15%). One study used 11 metrics (1.5%) and 2 studies used 13 metrics (3%). CONCLUSIONS: Spine surgery lacks consensus on the metrics used to report RUSH. While there are numerous metrics are used, there are no standardized guidelines to help researchers select these measures consistently across studies. Establishing a standardized set of RUSH metrics will enhance the ability to compare findings across studies, assess their validity, and correlate them with patient outcomes.