title: Outcomes and costs associated with hospitalist comanagement of medically complex children undergoing spinal fusion surgery.
abstract: OBJECTIVE
  The goal of this study was to assess outcomes and costs associated with hospitalist comanagement of medically complex children undergoing spinal fusion surgery for neuromuscular scoliosis.
  
  
  METHODS
  A hospitalist comanagement program was implemented at a children's hospital. We conducted a retrospective case series study of patients during 2003-2008 to compare clinical and cost outcomes for 87 preimplementation patients, 40 patients during a partially implemented program, and 80 patients during a fully implemented program.
  
  
  RESULTS
  When compared with preimplementation patients, full implementation program patients did not demonstrate a statistically significant difference in median length of stay on the medical/surgical unit after transfer from the PICU (median: 6 vs 8 days; P = .07). Patients in the full implementation group received fewer days of parenteral nutrition (median: 0 vs 6 days; P = .0006) and had fewer planned and unplanned laboratory studies on the inpatient unit. There was no statistically significant change in returns to the operating room (P = .08 between preimplementation and full implementation), other complications, or 30-day readmissions. Median hospital costs increased from preimplementation ($59372) to partial implementation ($89302) and remained elevated during full implementation ($81 651) compared with preimplementation (P = .004). Mean physician costs followed a similar trajectory from preimplementation ($18425) to partial implementation ($24101) to full implementation ($22578; P = .0006 [versus preimplementation]).
  
  
  CONCLUSIONS
  A hospitalist comanagement program can significantly affect the care of medically complex children undergoing spinal fusion surgery. Initial program costs may increase.
authors: Department of General Pediatrics, 1600 Rockland Rd, Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA. drappapo@nemours.org
authors: David I
authors: DI
authors: Rappaport
authors: Judy
authors: J
authors: Adelizzi-Delany
authors: Kenneth J
authors: KJ
authors: Rogers
authors: Chalanda E
authors: CE
authors: Jones
authors: Maria E
authors: ME
authors: Petrini
authors: Kate
authors: K
authors: Chaplinski
authors: Peter
authors: P
authors: Ostasewski
authors: Iman
authors: I
authors: Sharif
authors: David M
authors: DM
authors: Pressel
mesh_terms: D000293:Adolescent; D001848:Bone Diseases, Developmental / Q000150:complications / Q000191:economics / Q000628:therapy; D002547:Cerebral Palsy / Q000150:complications / Q000191:economics / Q000628:therapy*; D002648:Child; D003299:Cooperative Behavior; D005260:Female; D017721:Hospital Costs; D064416:Hospital Medicine / Q000191:economics / Q000379:methods*; D006776:Hospitals, Pediatric; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D009135:Muscular Diseases / Q000150:complications / Q000191:economics / Q000628:therapy; D009985:Orthopedics / Q000191:economics / Q000379:methods*; D010348:Patient Care Team / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D012600:Scoliosis / Q000191:economics / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000191:economics; D016896:Treatment Outcome