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

TitleOutcomes and costs associated with hospitalist comanagement of medically complex children undergoing spinal fusion surgery
Publication TypeJournal Article
Year of Publication2013
AuthorsRappaport, D. I., Adelizzi-Delany J., Rogers K. J., Jones C. E., Petrini M. E., Chaplinski K., Ostasewski P., Sharif I., & Pressel D. M.
JournalHospital pediatrics
Volume3
Issue3
Pagination233-41
Date Published2013 Jul
ISSN2154-1663
KeywordsAdolescent; Bone Diseases, Developmental; Cerebral Palsy; Child; Cooperative Behavior; Female; Hospital Costs; Hospital Medicine; Hospitals, Pediatric; Humans; Length of Stay; Male; Muscular Diseases; Orthopedics; Patient Care Team; Postoperative Complications; Retrospective Studies; Scoliosis; Spinal Fusion; Treatment Outcome
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.




Alternate JournalHosp Pediatr
Refereed DesignationRefereed