Pediatric hospitalist comanagement of spinal fusion surgery patients

✍ Scribed by Tamara D. Simon; Robert Eilert; L. Miriam Dickinson; Allison Kempe; Elise Benefield; Stephen Berman

• Book ID: 102345320
• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 246 KB
• Volume: 2
• Category: Article
• ISSN: 1553-5592
• DOI: 10.1002/jhm.144

✦ Synopsis

Abstract

BACKGROUND:

There are no published studies of hospitalist comanagement of pediatric surgical patients.

OBJECTIVES:

(1) To describe comanagement activities; (2) to determine the association of hospitalist comanagement with length of stay (LOS) following spinal fusion surgery

DESIGN:

Retrospective analysis of the surgeons' log.

SETTING:

Tertiary‐care pediatric hospital.

PATIENTS:

Patients who underwent initial spinal fusion surgery (n = 759) between July 2000 and October 2005.

INTERVENTION:

Hospitalist pre‐ and perioperative evaluation and management of medically complex patients (from December 2004 to October 2005).

MEASUREMENTS:

Log‐transformed LOS and trend in LOS by piecewise regression were measured, adjusting for patient covariates and clustering by surgeon.

RESULTS:

After December 2004, 12% of all spinal fusion surgery patients (14 of 115) were comanaged by a hospitalist. Nine‐three percent (13 of 14) of comanaged patients had neuromuscular scoliosis, and comanaged patients represented 37% (13 of 35) of all neuromuscular patients. Mean LOS for all spinal fusion surgeries decreased from 6.5 days (95% CI: 6.2–6.7) to 4.8 days (95% CI: 4.5–5.1) after December 2004. Mean LOS decreased more for neuromuscular patients (8.6 days [95% CI: 8.0– 9.2] to 6.2 days [95% CI: 5.5–6.9]) than for idiopathic patients (5.2 days [95% CI: 5.0–5.4] to 4.1 days [95% CI: 3.9–4.4]). Variability in LOS also decreased significantly for both groups. Prior to hospitalist comanagement, there was no change in adjusted LOS over time. After December 2004, there was a significant decline in average adjusted LOS (neuromuscular slope = −0.23 to −0.31 days/month, P = .0075; idiopathic slope = −0.10 to −0.12 days/month; P = .0007).

CONCLUSIONS:

The introduction of selective hospitalist comanagement of pediatric spinal fusion surgery patients was associated with significant decreases in LOS and variability in LOS. Journal of Hospital Medicine 2007;2:23–30. © 2007 Society of Hospital Medicine.