Pediatric Orthopedic Trauma at a Level II Trauma Center
Benefits of Coverage by Traumatologists
DOI:
https://doi.org/10.55576/job.v6i1.73Keywords:
Pediatric trauma, orthopaedic traumatologist, pediatric fractures, implant cost, healthcare resource utilization, cost-effectiveness, operating room efficiencyAbstract
Objectives: Compare implant costs, case duration, and rates of unplanned return to the operating room between pediatric trauma cases performed by fellowship-trained orthopedic traumatologists and those by fellowship-trained pediatric orthopedists.
Design: Retrospective comparative cohort study.
Setting: Non-academic, Level II trauma center
Patients/Participants: Trauma and fracture cases involving patients aged 18 or younger were identified over a 20-month period (1/1/23-8/31/24).
Intervention: Surgical treatment for traumatic orthopedic injury.
Main Outcome Measurements: Cases managed by four private practice traumatologists were compared with similar cases handled by two hospital-employed pediatric orthopedists. Cases were considered similar if they shared the same CPT code, fracture type, means of reduction, and manner of fixation. Mean implant costs, case duration (from incision to closure), and unplanned returns to the operating room were compared statistically.
Results: Three hundred seven pediatric trauma cases were identified, including 246 by traumatologists and 61 by pediatric orthopedists. Twelve similar case types were classified: proximal humerus open reduction internal fixation (ORIF), supracondylar humerus closed reduction percutaneous pinning (CRPP), medial epicondyle ORIF, lateral condyle ORIF, radius and/or ulna shaft ORIF, distal radius CRPP, slipped capital femoral epiphysis CRPP, flexible femoral shaft nailing, distal femur ORIF, tibial tubercle ORIF, rigid tibial nailing, and ankle ORIF. See Figure 1 for details.
In 9 of 12 case types, traumatologists had lower implant costs and shorter case durations. When average implant costs were combined, trauma surgeons used implants that were 52% cheaper than those used by pediatric surgeons. Pediatric surgeons took 35% longer than trauma surgeons, on average, for these 12 case types. Unplanned reoperation rates were similar between the two groups.
Conclusions: For comparable pediatric trauma cases, traumatologists completed cases 26% faster with 52% cheaper implants than pediatric orthopedists, with a lower unplanned reoperation rate. Pediatric trauma coverage by traumatologists may improve hospital resource allocation, enhance OR utilization, and provide financial benefits to patients and the healthcare system, while allowing pediatric orthopedists to focus on their elective practices.
Level of Evidence: Level III: Retrospective comparative cohort study at a single Level II trauma center.
Keywords: Pediatric trauma, orthopaedic traumatologist, pediatric fractures, implant cost, healthcare resource utilization, cost-effectiveness, operating room efficiency.
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