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.