Urban Pediatric Orthopaedic Surgical Practice Audit: Implications for the Future of This Subspecialty

The growth and development of the physis distinguishes the child from the adult. There are historical lines of referral that direct a substantial amount of elective procedures for adolescent idiopathic scoliosis and for hip and foot pathology in children and adolescents to pediatric orthopaedic surgeons. Over twenty million children are injured each year, with an incidence of one of every four children1,2. Trauma is the leading cause of death and disability in children3-6. Coincident with an ever-expanding amount of pediatric trauma, many general hospitals have terminated their pediatric trauma services7-9. These factors have resulted in increasing numbers of children presenting to pediatric orthopaedic surgical outpatient clinics and to pediatric hospitals, particularly those with active pediatric trauma programs. Trauma call responsibility has become an important quality-of-life issue for many pediatric orthopaedic surgeons8,10-15. In an attempt to better understand the status quo of pediatric orthopaedic surgical practice, we analyzed the pediatric orthopaedic surgical practice at our institution over the last decade with specific attention directed to the area of trauma surgery. Our goal was to specifically define the current surgical composition of an urban pediatric orthopaedic surgical practice and contrast it to the work done almost a decade earlier. This information should be of value to all practicing pediatric orthopaedic surgeons, residents considering a career in pediatric orthopaedics, hospital administrators, and orthopaedic training program directors designing an optimal residency training exposure. We utilized the operating-room computerized database of surgical cases at our institution to identify all pediatric orthopaedic surgical procedures done in the operating room for fiscal years 1998 and 1999 and compared them with data for fiscal years 2006 and 2007. If necessary, the operative reports were reviewed for further clarification of the …