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Published on: March 23, 2019
Comparison of 2 Models of Care for Children With Medical Complexity Following Spinal Fusion
Zachary Semenetz1,2, Amanda M Lewis3, Kamyar Arasteh3
1Sidney Kimmel Medical College, Thomas Jefferson University/Nemours Children's Hospital, Wilmington, DE, USA.
Insights
Patients with neuromuscular scoliosis after spinal fusion surgery managed by a complex care clinic (CCC) experienced shorter hospital stays. This study found no significant difference in readmission rates, suggesting potential benefits of CCCs for post-surgical care.
Area of Science:
- Orthopedics
- Healthcare Management
- Pediatric Surgery
Background:
- Neuromuscular scoliosis requires complex surgical management, often involving spinal fusion.
- Post-operative care for these patients presents challenges in resource utilization and patient outcomes.
- Existing care models may not fully address the unique needs of patients with neuromuscular scoliosis post-spinal fusion.
Purpose of the Study:
- To compare the effectiveness of a complex care clinic (CCC) versus traditional hospitalist/orthopedics co-management for post-operative care of patients with neuromuscular scoliosis following spinal fusion.
- To evaluate differences in length of stay (LOS) and 30-day readmission rates between the two care models.
- To assess secondary outcomes including resource utilization and complication rates.
Main Methods:
- Retrospective chart review of patients with neuromuscular scoliosis undergoing spinal fusion.
- Comparison of outcomes between patients managed by a CCC and those under hospitalist/orthopedics co-management.
- Propensity score weighting was used to adjust for baseline differences between the non-randomized groups.
Main Results:
- The complex care clinic (CCC) group demonstrated a significantly shorter length of stay (LOS) (coefficient = -2.60; P = .04).
- No significant difference was observed in 30-day readmission rates between the CCC and co-management groups (P = .62).
- The CCC group showed some significant resource utilization benefits without increased complication rates.
Conclusions:
- Management by a complex care clinic (CCC) may lead to improved efficiency, specifically a reduced length of stay, for patients with neuromuscular scoliosis after spinal fusion surgery.
- While LOS was reduced, the CCC model did not significantly impact 30-day readmission rates compared to traditional co-management.
- The findings suggest that specialized care models like CCCs can offer benefits in managing complex pediatric surgical populations post-operatively.
Abstract:
We conducted a retrospective chart review of patients with neuromuscular scoliosis following spinal fusion surgery who were cared for post-operatively by either a hospitalist/orthopedics co-management team or a complex care clinic (CCC). Assignment to either treatment group was not random. To account for baseline differences between groups, we calculated propensity scores and used these as probability weights in generalized linear models. After matching, the CCC had a shorter length of stay (LOS, coefficient = -2.60; P = .04) without a significant difference in 30-day readmission rate (P = .62). For secondary outcomes, there were some significant resource utilization benefits favoring the complex care group without significant difference in complication outcomes between groups. In managing patients after spinal fusion surgery, both groups had similar LOS compared with prior studies of children after spinal fusion surgery. Management by the CCC may confer some outcome benefits for their patients.
