Pediatric Specialization Associated with Lower Risk of Prolonged Hospital Stay after Femur Fracture

A study presented at the AAOS 2024 Annual Meeting found that pediatric patients undergoing surgical intervention for a femoral shaft fracture from a non-pediatric–trained orthopaedic surgeon were more likely to require an extended hospital stay (defined as >5.5 days) than patients treated by a pediatric orthopaedic surgeon.

According to the presenting author, Sean Tabaie, MD, FAAOS, assistant professor of orthopaedic surgery and medical director of the Motion Analysis Laboratory at Children’s National Hospital in Washington, D.C., “The study was prompted by the recognition that pediatric femoral shaft fractures, though constituting a small percentage of all fractures in children, are the most common fractures requiring hospitalization.” Acknowledging the uneven distribution of pediatric orthopaedic surgeons across the United States, Dr. Tabaie and his team compared outcomes after femoral shaft fracture repair by pediatric subspecialty–trained orthopaedic surgeons versus those by non-pediatric orthopaedic surgeons.

The researchers queried the National Surgical Quality Improvement Program–Pediatric database to identify patients aged <18 years who underwent open treatment for a femoral shaft fracture between 2012 and 2019. a total of 5,862 patients were included in the analysis, with 4,875 (83.2 percent) treated by pediatric surgeons and 987 (16.8 percent) by non-pediatric surgeons.

Patients with a higher American Society of Anesthesiologists classification and those with medical comorbidities, including gastrointestinal and neurological conditions, were more likely to be treated by a pediatric surgeon. Multivariable regression analysis demonstrated that patients treated by non-pediatric orthopaedic surgeons were at an increased risk of prolonged hospital stay (P <0.001) compared to those operated on by pediatric orthopaedic surgeons.

“These findings underscore the importance of considering the expertise of the surgeon and potential benefits of involving pediatric orthopaedic surgeons in the treatment of femoral shaft fractures in children,” Dr. Tabaie said.

He acknowledged the limitations of this study, including its retrospective design and the reliance on data from the National Surgical Quality Improvement Program–Pediatric database, which may have introduced biases. Additionally, the data did not include specific surgical techniques employed by pediatric and non-pediatric surgeons, which may have affected postoperative outcomes.

Dr. Tabaie also noted the need for further research “to validate and generalize the findings to different populations and healthcare settings.” Regarding further areas of exploration, Dr. Tabaie emphasized the specific reasons behind the observed differences in outcomes, the factors that may contribute to the maldistribution of pediatric surgeons across the country, and the long-term functional outcomes and quality of life for patients treated by both types of surgeons.

Poster e269 is available to view via the Annual Meeting Mobile App or online at aaos.org/ameducation.

Dr. Tabaie’s coauthors of “Comparison of Outcomes of Pediatric Femoral Shaft Fracture Repair by Pediatric and Nonpediatric Orthopedists” are Alex Gu, MD; Avilash Das; Brock Knapp; Bruce T. Seibold, BS; and Sophie Bernstein, BA.

Cailin Conner is the associate editor of AAOS Now. She can be reached at cconner@aaos.org.