Outcomes and Costs Associated With Hospitalist Comanagement of Medically Complex Children Undergoing Spinal Fusion Surgery

摘要

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 ($59 372) to partial implementation ($89 302) and remained elevated during full implementation ($81 651) compared with preimplementation ( P = .004). Mean physician costs followed a similar trajectory from preimplementation ($18 425) to partial implementation ($24 101) to full implementation ($22 578; 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.* Abbreviations: AED : antiepileptic drug EMR : electronic medical record IQR : interquartile range LOS : length of stay UTI : urinary tract infection