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Pediatric hospitalist comanagement of spinal fusion surgery patients
Tamara D Simon1, Robert Eilert, L Miriam Dickinson
1Department of Pediatrics, Division of Inpatient Medicine, University of Utah, Salt Lake City, Utah 84113, USA. Tamara.Simon@hsc.utah.edu
Insights
Hospitalist comanagement of pediatric spinal fusion surgery patients significantly reduced length of stay (LOS) and variability in LOS. This study highlights the benefits of hospitalist involvement in complex pediatric surgical care.
Area of Science:
- Pediatric Surgery
- Hospital Medicine
- Healthcare Management
Background:
- No prior studies documented hospitalist comanagement for pediatric surgical patients.
- This study addresses a gap in understanding the impact of hospitalist involvement in pediatric surgical care.
Purpose of the Study:
- To describe hospitalist comanagement activities for pediatric surgical patients.
- To evaluate the association between hospitalist comanagement and length of stay (LOS) after spinal fusion surgery.
Main Methods:
- Retrospective analysis of surgeon logs from a tertiary-care pediatric hospital.
- Included 759 patients undergoing initial spinal fusion surgery (July 2000-October 2005).
- Intervention involved hospitalist pre- and perioperative evaluation for medically complex patients from December 2004 to October 2005.
Main Results:
- Hospitalist comanagement was implemented in 12% of spinal fusion cases after December 2004, predominantly for neuromuscular scoliosis.
- Mean LOS decreased from 6.5 to 4.8 days for all spinal fusions, with greater reductions for neuromuscular and idiopathic scoliosis patients.
- Significant declines in average adjusted LOS and reduced variability were observed post-intervention.
Conclusions:
- Selective hospitalist comanagement of pediatric spinal fusion surgery patients is associated with significant reductions in LOS.
- The findings suggest that hospitalist involvement can improve efficiency and outcomes in pediatric surgical care.
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.
