Who is performing pediatric spine deformity surgery: a review of 37,443 patients

Pediatric spine surgery has traditionally been a subspecialty within pediatric orthopedics. This study aimed to analyze changes over time in the proportion of pediatric spinal deformity cases performed by orthopedic surgery and neurosurgery, and to identify trends in the practice patterns and peri-operative variables of these specialties.

This was a retrospective cohort study using the National Surgical Quality Improvement Program Pediatric database (NSQIP) years 2016-2022. Inclusion criteria are patients < 18 years of age undergoing posterior spinal instrumented fusion for spinal deformity. Outcomes included: specialty of surgeon (orthopedic surgery, pediatric orthopedic surgery, neurosurgery, pediatric neurosurgery), patient age (< 10 years vs. 10-18 years), perioperative allogeneic transfusion, 30-day reoperation, deep surgical site infection, operative time, and length of stay. Descriptive statistics, Chi-square test, and Students' t test were used for analysis.

There were 37,443 patients meeting inclusion criteria. Orthopedic surgery, pediatric orthopedic surgery, neurosurgery, and pediatric neurosurgery performed 8.0%, 90.4%, 0.2%, and 1.3% of the cases, respectively. From 2016 to 2022, there was an increase in the proportion of cases performed by pediatric neurosurgery from 0.7 to 1.2% and a decrease in the proportion of cases performed by pediatric orthopedic surgery from 93.2 to 87.6%. Pediatric neurosurgery performed the highest proportion of cases in patients < 10 years of age (10.8%, p < 0.001). Pediatric orthopedic surgery performed the lowest proportion of cases in patients that have had previous spinal deformity surgery (4.4%, p  < 0.001). Orthopedic surgery had the highest proportion of idiopathic cases (72.7%), whereas pediatric neurosurgery had the lowest (47.0%). For idiopathic scoliosis, neurosurgery and pediatric neurosurgery had higher rates of allogeneic transfusion (p  < 0.001) and longer lengths of stay (p  < 0.001). There were no differences in rates of 30-day reoperation or deep surgical site infection.

In the NSQIP database, the great majority of posterior spine fusions with instrumentation continue to be performed by pediatric orthopedic surgeons. Differences exist among these specialties in terms of patient demographics and perioperative surgical variables.