Association between self-reported mental health and resource utilization in patients undergoing elective lumbar fusion.

BACKGROUND

Mental health concerns are increasingly common in patients undergoing lumbar spine fusion. Recent studies have suggested that poor mental health leads to a greater risk of suboptimal recovery. However, few studies have investigated cost and resource allocation associated with patients with poor mental health. Therefore, this study was designed to understand how self-reported mental health, assessed by the PROMIS-10 Global Mental Health T-score (MHT), was associated with both hospital costs and post discharge resource utilization.

METHODS

A total of 1,211 patients that underwent 1- or 2-level elective lumbar fusion between June 2021 and June 2024, and completed a preoperative PROMIS-10 Global assessment were analyzed for this retrospective review. Patients were grouped based on their MHT: MHT >50 was considered above average (AA), MHT scores between 40 and 50 were average (A), and MHT <40 was considered below average (BA). Multivariate regressions were used to investigate the associations between the MHT score, cost and postdischarge resource utilization.

RESULTS

A total of 41.7% of the study cohort was in the A-MHT group, 31.5% was in the AA-MHT group, and 26.8% was in the BA-MHT group. There were no demographic differences among study groups. The AA-MHT group utilized significantly less resources than both the BA-MHT and A-MHT groups. Neither the MHT group nor diagnosed mental illness, were independently associated with cost (p=.572 and p=.646 respectively).

CONCLUSIONS

The findings of this study demonstrated that patients with below average mental health (MHT scores <40) may not be a risk for increased resource utilization or cost. However, the study results did suggest that patients with above average mental health (MHT scores >50) have better outcomes, and cost less than other groups during the initial recovery phase following elective lumbar fusions.