title: Pediatric surgery - a changing field: national trends in pediatric surgical practice.
abstract: BACKGROUND
  Over the last decade, our institution has experienced a relative increase in the number of mundane cases, such as appendectomy and incision and drainage of abscess, versus index (complex) cases. We sought to determine if this trend is present at the national level.
  
  
  METHODS
  A retrospective review of surgical case volume at 36 freestanding children's hospitals was performed between January 2004 and December 2013 using the Pediatric Health Information System (PHIS) database. Procedures were classified as "mundane" or "index", and 10 procedures of each type were selected for analysis. Results were reported as a percentage of total cases. Statistical analysis of linear trends was performed with the Mann-Kendall test.
  
  
  RESULTS
  Overall, index procedures had a significant downward trend (p<0.01), whereas mundane procedures had a significant upward trend (p<0.01). Individually, 5 mundane procedures had significant upward trends, and 3 had downward trends. Five index procedures had significant downward trends, and none had an upward trend.
  
  
  CONCLUSIONS
  The field of pediatric surgery is undergoing change with mundane procedures constituting an increasing proportion of the surgical caseload, while complex procedures are proportionately decreasing. These trends may be useful to inform decisions regarding future pediatric surgery workforce planning.
authors.affiliation: Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA.
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Bruns
authors.affiliation: Department of Quality and Patient Safety, Akron Children's Hospital, Akron, OH, USA.
authors.forename: M Abid
authors.initials: MA
authors.lastname: Shah
authors.affiliation: Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA.
authors.forename: Amelia N
authors.initials: AN
authors.lastname: Dorsey
authors.affiliation: Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Ponsky
authors.affiliation: Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA. Electronic address: osoldes@chmca.org.
authors.forename: Oliver S
authors.initials: OS
authors.lastname: Soldes
mesh_terms: D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D063005:Health Information Systems / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000639:trends*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013043:Specialties, Surgical / Q000639:trends*; D013514:Surgical Procedures, Operative / Q000145:classification* / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States / Q000453:epidemiology
keywords: Case mix; Pediatric surgery; Pediatric surgery workforce