title: Pediatric hospitalist comanagement of spinal fusion surgery patients.
abstract: BACKGROUND
  There are no published studies of hospitalist comanagement of pediatric surgical patients.
  
  
  OBJECTIVE
  (1) To describe comanagement activities; (2) to determine the association of hospitalist comanagement with length of stay (LOS) following spinal fusion surgery.
  
  
  METHODS
  Retrospective analysis of the surgeons' log.
  
  
  METHODS
  Tertiary-care pediatric hospital.
  
  
  METHODS
  Patients who underwent initial spinal fusion surgery (n = 759) between July 2000 and October 2005.
  
  
  METHODS
  Hospitalist pre- and perioperative evaluation and management of medically complex patients (from December 2004 to October 2005).
  
  
  METHODS
  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.
authors.affiliation: Department of Pediatrics, Division of Inpatient Medicine, University of Utah, Salt Lake City, Utah 84113, USA. Tamara.Simon@hsc.utah.edu
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Simon
authors.forename: Robert
authors.initials: R
authors.lastname: Eilert
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
authors.forename: Elise
authors.initials: E
authors.lastname: Benefield
authors.forename: Stephen
authors.initials: S
authors.lastname: Berman
mesh_terms: D000293:Adolescent; D002648:Child; D003120:Colorado; D020445:Hospitalists / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D009985:Orthopedics / Q000458:organization & administration / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000458:organization & administration / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000379:methods / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000706:statistics & numerical data*