Dance Sarah, Quan Theodore, Parel Philip M, Farley Benjamin J, Tabaie Sean
Orthopaedic Surgery, Children's National Hospital, Washington, DC, USA.
Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Cureus. 2024 Mar 11;16(3):e55951. doi: 10.7759/cureus.55951. eCollection 2024 Mar.
Objectives Developmental dysplasia of the hip (DDH) encompasses a spectrum of abnormalities in the immature hip. Surgical intervention is indicated if conservative management fails. Despite the increased supply of pediatric orthopedic surgeons (POSs) over the last few decades, there continues to be a maldistribution of surgeons. The purpose of this study is to determine outcomes following surgical management of hip dysplasia by POSs compared to non-pediatric orthopedic surgeons. Methods Pediatric patients who underwent surgical treatment for hip dysplasia from 2012 to 2019 were identified using a large national database. Patient demographics, comorbidities, and postoperative complications were compared by pediatric versus nonpediatric-trained orthopedic surgeons. Bivariate and multivariable regression analyses were performed. Results Of the 10,780 pediatric patients who underwent hip dysplasia surgery, 10,206 patients (94.7%) were operated on by a POS, whereas 574 (5.3%) were operated on by a non-pediatric orthopedic surgeon. POSs were more likely to operate on patients with a higher American Society of Anesthesiologists class (p<0.001) and those with a greater number of medical comorbidities, including cardiac (p=0.001), gastrointestinal (p=0.017), and neurological (p<0.001). Following analysis using multivariable regression models to control for patient baseline characteristics, there were no differences in any postoperative complications between patients treated by pediatric-trained and nonpediatric-trained orthopedic surgeons. Conclusions Compared to non-pediatric orthopedic surgeons, POSs were more likely to operate on younger patients with increased medical comorbidities. However, there were no differences in postoperative complications following surgical management for DDH in patients treated by nonpediatric and pediatric orthopedic surgeons.
目的 发育性髋关节发育不良（DDH）涵盖了未成熟髋关节的一系列异常情况。如果保守治疗失败，则需进行手术干预。尽管在过去几十年里儿科骨科医生（POSs）的数量有所增加，但外科医生的分布仍然不均衡。本研究的目的是确定与非儿科骨科医生相比，POSs对髋关节发育不良进行手术治疗后的结果。方法 使用一个大型国家数据库确定2012年至2019年期间接受髋关节发育不良手术治疗的儿科患者。比较儿科与非儿科培训的骨科医生的患者人口统计学、合并症和术后并发症情况。进行了双变量和多变量回归分析。结果 在10780例接受髋关节发育不良手术的儿科患者中，10206例（94.7%）由POSs进行手术，而574例（5.3%）由非儿科骨科医生进行手术。POSs更有可能为美国麻醉医师协会分级较高（p<0.001）以及患有更多合并症的患者进行手术，包括心脏疾病（p=0.001）、胃肠道疾病（p=0.017）和神经系统疾病（p<0.001）。在使用多变量回归模型控制患者基线特征后，儿科培训和非儿科培训的骨科医生治疗的患者在任何术后并发症方面均无差异。结论 与非儿科骨科医生相比，POSs更有可能为合并症增加的年轻患者进行手术。然而，非儿科和儿科骨科医生治疗的DDH患者手术治疗后的术后并发症并无差异。
