SLAP TEARS IN THE PEDIATRIC PATIENT: WHO IS TREATING THEM AND WHERE?

Abstract

BACKGROUND: Although rare in comparison to adult cohorts, superior labral anterior to posterior (SLAP) tears do occur in children and adolescents. Previous publications have focused on the varied surgical treatments of SLAP tears in pediatric hospitals but have not stratified treatments by surgeon training or hospital setting. The objective of this study is to evaluate the demographics of patients under the age of 18 undergoing SLAP surgery as well as to evaluate the influence of hospital setting (hospital self-designation as pediatric vs. non-pediatric) and the trends of treatment choice (debridement versus repair) over a period of time. METHODS: The California statewide outpatient database (OSHPD) was queried for all patients under 18 years old who underwent a SLAP debridement or repair in the state of California between 2008 and 2016. The effect of age, hospital setting (pediatric versus adult hospital), gender, insurance type, race, and year of service were assessed using logistic regression. RESULTS: A total of 1,349 patients under age 18 years underwent surgery for a SLAP tear between 2008 and 2016. SLAP repair was performed in 83.8% of patients while SLAP debridement was performed in 16.2% of patients. 80.9% of patients were treated at non-children’s hospitals and 19.1% were treated at children’s hospitals. At non-children’s hospitals, 161 (14.7%) had SLAP debridement and 931 (85.3%) had SLAP repair. At children’s hospitals, 57 patients (22.2%) had SLAP debridement and 200 (77.8%) had SLAP repair. The odds of having a SLAP repair over SLAP debridement decreases by a factor of .58 (p < 0.01) when patients have surgery at a children’s hospital versus at a non-children’s hospital. Age, gender, race, and insurance type were not statistically significant in predicting whether patients underwent SLAP repair versus debridement. Analysis of each individual year of service over the study period from 2008 to 2016 revealed the odds of having a SLAP repair over debridement increased each year by a factor of 1.1 (p < 0.001). CONCLUSIONS: The majority of surgeries treating SLAP tears in patients under the age of 18 are performed in non-pediatric hospitals. However, previous literature reporting on outcomes of SLAP surgery on patients under 18 is based in tertiary care pediatric centers,, which is likely not representative of this patient population. We hypothesize that this discrepancy may be due to shoulder surgeries more often being performed by sports medicine trained orthopedic surgeons who are not tied to operating in pediatric hospitals. Further, the yearly increased rate of SLAP repair over debridement is likely due to the prevailing knowledge in the orthopedic sports literature that repair is preferable to debridement in younger patients.