儿童骨科护理：谁来提供？在过去十年中发生了怎样的变化？对美国骨科手术委员会数据库的分析

Orthopaedic Care for Children: Who Provides It? How Has It Changed Over the Past Decade? Analysis of the Database of the American Board of Orthopaedic Surgery.

作者信息

Hosseinzadeh Pooya, Obey Mitchel R, Nielsen Ena, Andras Lindsay, Kiebzak Gary M, Mignemi Megan, Sawyer Jeffrey R, Albanese Stephen, Flynn John M

机构信息

Washington University School of Medicine, St. Louis, MO.

University of Souther California.

出版信息

J Pediatr Orthop. 2019 Mar;39(3):e227-e231. doi: 10.1097/BPO.0000000000001277.

DOI:10.1097/BPO.0000000000001277

PMID:30358690

Abstract

BACKGROUND

The field of orthopaedic surgery has subspecialized over the past decade with an increasing number of graduates of orthopaedic residency programs entering fellowship training. The number of graduates from pediatric orthopaedic fellowships has also increased over the past decade. We hypothesize as the number of pediatric orthopaedic fellowship graduates has increased, the proportion of orthopaedic cases completed by pediatric surgeons in comparison with adult surgeons has also increased. We have used the database of the American Board of Orthopaedic Surgery (ABOS) to analyze the trends in who is providing the orthopaedic care for children.

METHODS

Procedure logs of applicants for ABOS part II certification from 2004 to 2014 were collected and pediatric cases were used for this study. Applicants were divided into pediatric orthopaedic surgeons and adult orthopaedic surgeons based on the self-declared subspecialty for part II examination. CPT codes were used to place the cases into different categories. Descriptive and statistical analysis were performed to evaluate the change in the practice of pediatric orthopaedics over the past decade.

RESULTS

ABOS part II applicants performed 102,424 pediatric cases during this period. In total, 66,745 (65%) cases were performed by nonpediatric surgeons and 35,679 cases (35%) by pediatric surgeons. In total, 82% of the pediatric cases were done by adult surgeons in 2004 which decreased to 69% in 2009 and to 53% in 2014 (r=0.8232, P=0.0019). In pediatric sports medicine, pediatric orthopaedic surgeons performed 7% of the cases in 2004 which increased to 14% in 2009 and to 28% in 2014 (300% increase from 2004). Pediatric surgeons also increased their share of pediatric trauma cases. In total, 12% of lower extremity trauma cases were attended by pediatric surgeons in 2004 compared with 47% in 2014 (235% increase from 2004). In upper extremity trauma, pediatric surgeons increased their share of the cases from 12% in 2004 to 43% in 2014 (175% increase from 2004).

CONCLUSIONS

Over the past decade, pediatric orthopaedic specialists are caring for an increasing share of pediatric cases. Pediatric trauma, pediatric spine, and pediatric sports medicine have seen the greatest increase in the percentage of cases performed by pediatric orthopaedic surgeons.

LEVEL OF EVIDENCE

Level III.

摘要

背景

在过去十年中，骨外科领域已细分，越来越多的骨科住院医师培训项目毕业生进入专科 fellowship 培训。在过去十年中，儿科骨科 fellowship 的毕业生数量也有所增加。我们假设，随着儿科骨科 fellowship 毕业生数量的增加，与成人外科医生相比，儿科外科医生完成的骨科病例比例也有所增加。我们使用了美国骨科手术委员会（ABOS）的数据库来分析为儿童提供骨科护理的人员趋势。

方法

收集了 2004 年至 2014 年 ABOS 第二部分认证申请人的手术记录，并将儿科病例用于本研究。根据申请人在第二部分考试中自我申报的专科，将其分为儿科骨科医生和成人骨科医生。使用 CPT 代码将病例分为不同类别。进行描述性和统计分析，以评估过去十年中儿科骨科实践的变化。

结果

在此期间，ABOS 第二部分申请人共进行了 102,424 例儿科手术。其中，66,745 例（65%）由非儿科外科医生进行，35,679 例（35%）由儿科外科医生进行。总体而言，2004 年 82%的儿科病例由成人外科医生完成，2009 年降至 69%，2014 年降至 53%（r = 0.8232，P = 0.0019）。在儿科运动医学领域，儿科骨科医生在 2004 年完成了 7%的病例，2009 年增至 14%，2014 年增至 28%（比 2004 年增加了 300%）。儿科外科医生在儿科创伤病例中的占比也有所增加。2004 年，12%的下肢创伤病例由儿科外科医生处理，而 2014 年这一比例为 47%（比 2004 年增加了 235%）。在上肢创伤方面，儿科外科医生处理的病例比例从 2004 年的 12%增加到 2014 年的 43%（比 2004 年增加了 175%）。