P0990 - Trends in Pediatric Surgical Practice in North Carolina: The Effect of Pediatric Surgeon Proliferation on Practice Patterns

Introduction: Pediatric surgical workforce studies primarily examine the proliferation of pediatric surgeons (PS), geographic distribution, and the volume of index cases. There are little data on the effect this proliferation has on the delivery of overall surgical care to patients ≤18 years old. We hypothesize that the proportion of PS performing cases previously performed by general surgeons (GS) has increased over time.

Methods: We performed a retrospective review of the North Carolina Hospital Discharge Database from 2009-2017. Records for pediatric patients (≤18 years) undergoing the most frequent general pediatric surgery procedures were included. The surgical provider was categorized into PS and GS. Bivariate analysis was performed over the year of presentation and by type of surgical provider.

Results: During the study, 73,975 pediatric patients had included procedures. Overall, PS and GS performed 42.5% (n=31,470) and 30.5% (n=22,530) of the operations, respectively. The proportion of all qualifying cases performed by PS has trended upwards from 35.2% (n=2,807) to 44.2% (n=3,908) in 2009 and 2017, respectively. This trend is primarily attributable to change in the operative surgeon for the four most common operations performed, which compose 70.2% of cases. This includes appendectomy, inguinal hernia repair, umbilical hernia repair, and cholecystectomy. The proportion of these cases performed by PS increased more than 10% for appendectomies, inguinal herniorrhaphies, umbilical herniorrhaphies, and cholecystectomies from 2009 to 2017, Table 1. There was no difference in the proportion of congenital, oncologic, and bowel surgeries performed during the study.

Conclusion: The most common pediatric surgical procedures performed in North Carolina are increasingly performed by PS. This suggests increases in the pediatric surgical workforce results in a rise in the proportion of basic general surgical procedures, rather than complex congenital or oncologic surgeries. Pediatric surgical workforce training policies must be cognizant of these evolving surgical practice realities.