Abstract
Background:
The field of orthopaedic surgery is increasingly sub-specializing, with the number of pediatric fellowship programs more than doubling over the last 20 years. There is little research on whether increasing the number of pediatric orthopaedic surgeons has also increased the proportion of pediatric cases they perform compared to their non-fellowship trained (“adult”) orthopaedic peers. This study aims to identify the top 10 most performed cases in pediatric patients, the proportion of which are performed by pediatric surgeons, and how these trends have changed over the last 2 decades
Hypothesis:
We hypothesized, that there would be a significant increase in the proportion of pediatric orthopaedic procedures completed by those with sub specialization in pediatrics compared to seventeen years ago.
Methods:
Procedure logs of applicants for American Board of Orthopaedic Surgery (ABOS) part II certification from 2005 to 2022 were collected, and applicants were divided into pediatric and adult orthopaedic surgeons based on their self-declared subspeciality. Applicants’ procedure logs are organized by Current Procedural Terminology (CPT) codes to specify the exact medical care provided. Using descriptive and statistical analysis, we quantified trends on the proportion of orthopaedic care in pediatric patients (defined as <18 years of age) provided by pediatric and adult surgeons over a seventeen-year period. Correlations (Pearson r) were utilized to examine trends from 2005 to 2022. Using the χ2 test, p-values were calculated for each CPT code to determine whether the slope of the best-fit line deviated significantly from 0 (statistical significance was defined as a p-value <0.05).
Results:
ABOS applicants performed 169,683 pediatric orthopaedic surgery cases over a seventeen-year period. 110,581 (65.2%) cases were performed by adult surgeons and 59,102 (34.8%) cases were performed by pediatric surgeons. 14.5% of cases were performed by pediatric surgeons in 2005, which showed increases to 37.8% in 2014 and 44.6% in 2022 (r=0.8794, p<0.001). The top 10 most performed CPT codes in pediatric patients spanned procedures in trauma and sports medicine (Table 1). 9 of the top 10 (90%) exhibited statistically significant increases in the proportion of cases performed by pediatric surgeons over the study period (p<0.01).
Conclusion:
The proportion of pediatric orthopaedic procedures performed by pediatric orthopaedic surgeons continued to grow over a seventeen-year period. The top 10 most performed procedures are in pediatric trauma and sports medicine. However, the majority of pediatric orthopaedic surgery cases are still performed by adult surgeons, underscoring the importance of pediatric training in general orthopaedic residency.
