Outcomes and costs associated with hospitalist comanagement of medically complex children undergoing spinal fusion surgery

Hosp Pediatr. 2013 Jul;3(3):233-41. doi: 10.1542/hpeds.2012-0066.

Abstract

Objective: The goal of this study was to assess outcomes and costs associated with hospitalist comanagement of medically complex children undergoing spinal fusion surgery for neuromuscular scoliosis.

Methods: A hospitalist comanagement program was implemented at a children's hospital. We conducted a retrospective case series study of patients during 2003-2008 to compare clinical and cost outcomes for 87 preimplementation patients, 40 patients during a partially implemented program, and 80 patients during a fully implemented program.

Results: When compared with preimplementation patients, full implementation program patients did not demonstrate a statistically significant difference in median length of stay on the medical/surgical unit after transfer from the PICU (median: 6 vs 8 days; P = .07). Patients in the full implementation group received fewer days of parenteral nutrition (median: 0 vs 6 days; P = .0006) and had fewer planned and unplanned laboratory studies on the inpatient unit. There was no statistically significant change in returns to the operating room (P = .08 between preimplementation and full implementation), other complications, or 30-day readmissions. Median hospital costs increased from preimplementation ($59372) to partial implementation ($89302) and remained elevated during full implementation ($81 651) compared with preimplementation (P = .004). Mean physician costs followed a similar trajectory from preimplementation ($18425) to partial implementation ($24101) to full implementation ($22578; P = .0006 [versus preimplementation]).

Conclusions: A hospitalist comanagement program can significantly affect the care of medically complex children undergoing spinal fusion surgery. Initial program costs may increase.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Bone Diseases, Developmental / complications
  • Bone Diseases, Developmental / economics
  • Bone Diseases, Developmental / therapy
  • Cerebral Palsy / complications
  • Cerebral Palsy / economics
  • Cerebral Palsy / therapy*
  • Child
  • Cooperative Behavior
  • Female
  • Hospital Costs
  • Hospital Medicine / economics
  • Hospital Medicine / methods*
  • Hospitals, Pediatric
  • Humans
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Male
  • Muscular Diseases / complications
  • Muscular Diseases / economics
  • Muscular Diseases / therapy
  • Orthopedics / economics
  • Orthopedics / methods*
  • Patient Care Team / economics
  • Postoperative Complications / economics
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Scoliosis / economics
  • Scoliosis / etiology
  • Scoliosis / surgery*
  • Spinal Fusion / economics
  • Treatment Outcome