Outcomes and Costs Associated With Hospitalist Comanagement of Medically Complex Children Undergoing Spinal Fusion Surgery

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.