LAUSR

OBJECTIVE Define the training background of the actual surgical workforce providing care to pediatric patients in North Carolina (NC). BACKGROUND Due to database limitations, pediatric surgical workforce studies have not included general surgeons (GS) who operate on children. Defining the role of GS in care delivery affects policy for clinical care and general and pediatric surgical training. METHODS We performed a retrospective review of the North Carolina (NC) Hospital Discharge Database (2011-2017), including pediatric patients (≤18 years) undergoing the most frequent general surgery procedures. Descriptive and correlational analysis over surgical provider ([Pediatric Surgeon (PS), GS)], and other specialties [OSS], was performed using logistic regression modeling to identify factors associated with surgery by a PS. RESULTS Of the 57,265 discharges analyzed, pediatric, general, and other specialty surgeons operated on 25,514 (44.6%), 18,581 (32.5%), and 9,049 (15.8%), respectively. In a logistic regression model, PS had lower odds of operating on older patients (OR 0.9, CI 95% 0.90, 0.91). However, PS were more likely to operate on female patients (OR 1.58, 95% CI 1.53, 1.65), Black (OR 1.49, 95% CI 1.43, 1.56) and other minority patients (OR 1.23, 95% CI 1.17, 1.29) when compared to white patients. PS were also more likely to operate on patients with private insurance (OR 1.38, 95% CI 1.33, 1.43) compared to government insurance, and patients undergoing emergency surgery (OR 1.44, 95% CI 1.38, 1.50). CONCLUSION In NC, general surgeons performed a third of the operations on children. After controlling for covariates, pediatric surgeons in NC are more likely to operate on minority and emergency surgery patients, and this is the first study to describe this important practice pattern.