title: Pediatric hospitalist preoperative evaluation of children with neuromuscular scoliosis.
abstract: This is the first study of a pediatric hospitalist preoperative clinic. Pediatric hospitalists frequently make significant recommendations for patients with neuromuscular scoliosis prior to spinal surgery, especially those with medical complexity. Certain clinical criteria are statistically significantly associated with a hospitalist making a preoperative recommendation.
  
  
  OBJECTIVE
  To assess (1) how frequently pediatric hospitalists make recommendations when evaluating preoperative neuromuscular scoliosis patients in anticipation of spinal fusion surgery and (2) evaluate if any clinical characteristics are associated with a higher likelihood of hospitalists doing so.
  
  
  METHODS
  We performed a case series study using retrospective chart review of 214 patients scheduled for spinal fusion surgery for neuromuscular scoliosis from November 2009 through September 2012.
  
  
  RESULTS
  We analyzed data for 214 patients aged 1 to 20 years (median, 13 years), of whom 155 (72%) received at least 1 specific preoperative recommendation, whereas 59 patients (28%) were cleared for surgery without specific recommendations. Underlying diagnosis (P = 0.024), nonambulatory status (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.09-3.74), and increased number of preoperative medications (OR: 1.19, 95% CI: 1.06-1.34) were statistically significantly associated with an increased rate of receiving preoperative recommendations from the hospitalist. Comorbidities such as seizure disorder (OR: 2.68, 95% CI: 1.29-5.57) and gastrointestinal conditions (OR: 3.35, 95% CI: 1.74-6.45) were also statistically significantly associated with specific presurgical recommendations being made by the pediatric hospitalist.
  
  
  CONCLUSIONS
  A pediatric hospitalist preoperative program for children with neuromuscular scoliosis in anticipation of spinal fusion surgery is associated with a high rate of recommendations being made, especially in children with certain clinical characteristics.
authors.affiliation: Department of General Pediatrics, Nemours/AI duPont Hospital, Wilmington, Delaware; Jefferson Medical College, Philadelphia, Pennsylvania.
authors.forename: David I
authors.initials: DI
authors.lastname: Rappaport
authors.forename: Samantha
authors.initials: S
authors.lastname: Cerra
authors.forename: Jobayer
authors.initials: J
authors.lastname: Hossain
authors.forename: Iman
authors.initials: I
authors.lastname: Sharif
authors.forename: David M
authors.initials: DM
authors.lastname: Pressel
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D020445:Hospitalists / Q000592:standards*; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods / Q000592:standards*; D012189:Retrospective Studies; D012600:Scoliosis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult