Past Studies
Volume of Scoliosis Surgery Amongst Surgeons with Spine versus Pediatric Orthopaedic Fellowship Training in the States of New York and California
 Introduction:
There is a lot of discussion revolving around how best to train surgeons who will be performing spinal surgery on children and young adults with scoliosis. Some studies have found that doctors who perform more operations get better results, but these studies did not deal with pediatric orthopaedic surgeons. This study looked at the amount of surgeries performed by a doctor and whether the doctor's fellowship (the last year of training, several years after medical school, before a doctor can practice on his/her own) was specifically in a spine surgery, or to in pediatric orthopaedics.
Methods:
Using hospital records, the number of spinal fusions performed on patients under 25 years of age was recorded for New York, and we looked at who performed more of these operations; doctors whose fellowship training was in spine surgery or doctors whose fellowship training was in pediatric orthopaedics. We also looked at the spine fusions on patients under 25 in California, the most populated state in the US, and determined which fellowship programs did more fusions; pediatric orthopaedic, or spine.
Results:
In New York, the group of doctors who were trained as pepdiatric orthopaedics averaged 141 cases per surgeon, compared to 109 cases per surgeon among the doctors trained as, a difference that was not statistically significant. Three active pediatric orthopedic fellowship programs and 8 active spine surgery fellowship programs performing scoliosis surgery were identified during the time period studied in the state of California. An analysis of the number of cases per fellow revealed that the annual volume of scoliosis surgeries per fellow was 39.56 cases/year in pediatric orthopaedic surgery programs, and 20.69 cases/year in spine surgery programs.
Conclusion:
From 1992 to 2001 in New York state, most spinal fusion operations on patients with scoliosis were performed by a relatively small number of surgeons. These data suggest that there are an overwhelming number of surgeons who are performing <5 cases per year. An analysis of the number of cases per fellow in California demonstrated that pediatric orthopaedic fellows were exposed to nearly double the case load of scoliosis surgeries per year. While the current analyses reveal differences in the quantity of procedures performed by surgeons with different fellowship training and at hospitals associated with different fellowship training programs, they do not measure the quality of the structure and the education provided by such programs
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