What Proportion of Pediatric Surgical Cases are Performed by Early Career Pediatric Orthopaedic Surgeons? A 17-Year Study Using the ABOS Database.

BACKGROUND

Orthopaedic surgery residency graduates are more likely to pursue subspecialty fellowship training than ever before. Pediatric fellowship positions have doubled over the last 20 years, and fellowship accreditation requirements have changed within the last decade. However, little research exists on the effect of increased pediatric fellowship graduates on who provides orthopaedic care to children. We hypothesize that the proportion of pediatric orthopaedic cases performed by pediatric surgeons has increased over the past 2 decades, compared with adult counterparts.

METHODS

Procedure logs of applicants for American Board of Orthopaedic Surgery (ABOS) part II certification from 2005 to 2022 were collected. Applicants are divided into pediatric and adult orthopaedic surgeons, and reports include 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 provided by pediatric surgeons compared with their adult counterparts over a 17-year period. We stratified trends by age, comparing "child" (<13) and "adolescent" (13 to 18) patients, and by the subspecialty of the procedure.

RESULTS

During the study period, ABOS part II applicants performed 169,683 pediatric orthopaedic surgery cases. A total of 110,581 (65.2%) cases were performed by adult surgeons and 59,102 (34.8%) cases were performed by pediatric surgeons. A total of 14.5% of cases were performed by pediatric surgeons in 2005, which increased to 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, 9 of which (90%) exhibited statistically significant increases in the proportion of cases performed by pediatric surgeons over the study period (P<0.01). Similar increases were exhibited when stratified by age.

CONCLUSIONS

Over a 17-year span, pediatric surgeons perform a greater proportion of pediatric orthopaedic cases. When stratifying by patient age or by the top 10 most performed procedures, these trends persist. However, most pediatric cases are still performed by adult surgeons, underscoring the importance of pediatric training in general orthopaedic residency.

LEVEL OF EVIDENCE

Level III.