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Pediatric hospitalist comanagement of spinal fusion surgery patients

2007; Wiley; Volume: 2; Issue: 1 Linguagem: Inglês

10.1002/jhm.144

1553-5606

Tamara D. Simon, Robert E. Eilert, L. Miriam Dickinson, Allison Kempe, Elise Benefield, Stephen Berman,

Emergency and Acute Care Studies

There are no published studies of hospitalist comanagement of pediatric surgical patients.(1) To describe comanagement activities; (2) to determine the association of hospitalist comanagement with length of stay (LOS) following spinal fusion surgery.Retrospective analysis of the surgeons' log.Tertiary-care pediatric hospital.Patients who underwent initial spinal fusion surgery (n = 759) between July 2000 and October 2005.Hospitalist pre- and perioperative evaluation and management of medically complex patients (from December 2004 to October 2005).Log-transformed LOS and trend in LOS by piecewise regression were measured, adjusting for patient covariates and clustering by surgeon.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).The introduction of selective hospitalist comanagement of pediatric spinal fusion surgery patients was associated with significant decreases in LOS and variability in LOS.