Reich Daniel A, Herbst Katherine W, Campbell Brendan T
Department of Pediatric Surgery, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA.
Department of Pediatric Surgery/Department of Research, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA.
Pediatr Surg Int. 2019 Apr;35(4):517-522. doi: 10.1007/s00383-018-04433-6. Epub 2019 Jan 3.
Our objective was to determine if there was an association between subspecialist supply and a specific sub-set of procedures performed by pediatric surgeons over a 10-year period.
Data source was the Pediatric Health Information Systems database. Included were patients < 12 years who underwent one of nine outpatient surgical procedures between 1/1/2005 and 12/31/2014. Procedures were grouped into categories: pediatric surgery cases (PS), overlapping otolaryngology cases (OO), and overlapping urology cases (OU). Outcomes were number of cases performed by pediatric surgeons per pediatric surgeon, and proportion of cases performed by pediatric surgeons. Linear regression was used to test for association and temporal trends.
Included were 193,695 procedures, 18.9% PS, 4.8% OO, and 76.3% OU. There was a strong association between specialty supply and number of cases performed by pediatric surgeons. Temporally, there was no change in proportion of pediatric surgeons who performed PS cases (R = 0.08, p = 0.08), but a downward trend in proportion of OO (R = 0.82, p < 0.001) and OU cases. (R = 0.79; p < 0.001.) CONCLUSION: We found an association between physician supply and pediatric surgeon case type, and a reduction in OO and OU cases performed by pediatric surgeons. These findings suggest a narrowing of case-mix for pediatric surgeons.
我们的目标是确定在10年期间，专科医生供应与儿科外科医生所进行的特定手术子集之间是否存在关联。
数据来源是儿科健康信息系统数据库。纳入的是2005年1月1日至2014年12月31日期间接受九种门诊手术之一的12岁以下患者。手术分为几类：儿科手术病例（PS）、重叠的耳鼻喉科病例（OO）和重叠的泌尿外科病例（OU）。结果指标是每位儿科外科医生所进行的病例数，以及儿科外科医生所进行病例的比例。使用线性回归来检验关联和时间趋势。
共纳入193,695例手术，其中18.9%为PS，4.8%为OO，76.3%为OU。专科医生供应与儿科外科医生所进行的病例数之间存在强烈关联。在时间上，进行PS病例的儿科外科医生比例没有变化（R = 0.08，p = 0.08），但OO（R = 0.82，p < 0.001）和OU病例的比例呈下降趋势（R = 0.79；p < 0.001）。结论：我们发现医生供应与儿科外科医生的病例类型之间存在关联，并且儿科外科医生进行的OO和OU病例有所减少。这些发现表明儿科外科医生的病例组合范围正在缩小。
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