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Pediatric surgery - a changing field: national trends in pediatric surgical practice
Nicholas E Bruns1, M Abid Shah2, Amelia N Dorsey1
1Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA.
Insights
Pediatric surgery caseloads are shifting nationally. Mundane procedures are increasing, while complex index procedures are decreasing, impacting surgical training and workforce planning.
Area of Science:
- Pediatric Surgery
- Surgical Case Volume Analysis
Background:
- Institutions observe a rise in routine surgical cases (e.g., appendectomy) compared to complex index cases.
- This study investigates if this trend is a national phenomenon in pediatric surgery.
Purpose of the Study:
- To analyze national trends in pediatric surgical case volumes.
- To compare the proportion of mundane versus index procedures over time.
Main Methods:
- Retrospective analysis of the Pediatric Health Information System (PHIS) database (2004-2013).
- Involved 36 children's hospitals, classifying procedures as 'mundane' or 'index'.
- Used Mann-Kendall test for statistical analysis of linear trends.
Main Results:
- Significant national upward trend in mundane procedures (p<0.01).
- Significant national downward trend in index procedures (p<0.01).
- Specific mundane procedures showed upward trends, while index procedures showed downward trends.
Conclusions:
- Pediatric surgery caseloads are shifting towards a higher proportion of mundane procedures.
- Complex index procedures are proportionally decreasing in pediatric surgery.
- These trends have implications for pediatric surgical workforce planning and training.
Background:
Over the last decade, our institution has experienced a relative increase in the number of mundane cases, such as appendectomy and incision and drainage of abscess, versus index (complex) cases. We sought to determine if this trend is present at the national level.
Methods:
A retrospective review of surgical case volume at 36 freestanding children's hospitals was performed between January 2004 and December 2013 using the Pediatric Health Information System (PHIS) database. Procedures were classified as "mundane" or "index", and 10 procedures of each type were selected for analysis. Results were reported as a percentage of total cases. Statistical analysis of linear trends was performed with the Mann-Kendall test.
Results:
Overall, index procedures had a significant downward trend (p<0.01), whereas mundane procedures had a significant upward trend (p<0.01). Individually, 5 mundane procedures had significant upward trends, and 3 had downward trends. Five index procedures had significant downward trends, and none had an upward trend.
Conclusion:
The field of pediatric surgery is undergoing change with mundane procedures constituting an increasing proportion of the surgical caseload, while complex procedures are proportionately decreasing. These trends may be useful to inform decisions regarding future pediatric surgery workforce planning.
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