What are the most common pediatric surgical cases?

Most Common Pediatric Surgical Cases

Tonsillectomy (with or without adenoidectomy) is the most common pediatric surgical procedure, with over 530,000 procedures performed annually in children under 15 years, followed by inguinal hernia repair and appendectomy. 1

High-Volume Pediatric Surgical Procedures

Most Frequent Operations

The top pediatric surgical cases based on national data include:

• Tonsillectomy/Adenotonsillectomy: The second most common ambulatory surgical procedure in children, with 289,000-530,000 procedures annually in children under 15 years. 1

  • Primary indications are recurrent throat infections and obstructive sleep-disordered breathing (oSDB). 1
  • Sleep-disordered breathing has become the predominant indication, surpassing infectious indications since the 1980s. 1

• Appendectomy: The most commonly performed procedure by practicing pediatric surgeons, with a mean of 49.3 procedures per surgeon annually. 2

  • Represents one of the top 3 most frequent inpatient pediatric surgical procedures. 3

• Inguinal Hernia Repair: The third most common procedure, with surgeons performing a mean of 14.7 repairs annually in infants under 6 months alone. 2, 4

  • Remains one of the most common pediatric surgical procedures overall. 5, 6, 4

• Nonoperative Trauma Management: Second most common activity for pediatric surgeons, with a mean of 20.0 cases per surgeon annually. 2

Additional Common Procedures

• Umbilical hernia repair: Frequently performed elective procedure in childhood. 6
• Orchidopexy for cryptorchidism: Common planned surgical intervention. 6
• Circumcision for phimosis: Routine elective procedure. 6
• Pyloromyotomy: Common neonatal/infant procedure. 5
• Cholecystectomy: Shows significant regional variation in frequency. 3

Important Clinical Context

Volume Distribution

Approximately 40% of all pediatric inpatient surgical procedures occur in adult general hospitals rather than dedicated children's facilities. 3

• Complex, low-volume neonatal procedures (Hirschsprung pullthrough, malrotation surgery, esophageal atresia repair, diaphragmatic hernia repair) are 6.8 to 16 times more likely to be performed at children's hospitals. 3
• The top 20 procedures account for over 90% of all pediatric inpatient surgical cases. 3

Rare Procedures

For 6 of 10 "rare" pediatric surgery index cases, practicing surgeons perform fewer than 2 procedures annually on average. 2

• Only 62.7% of surgeons performed a neuroblastoma resection in the preceding year. 2
• Only 55.2% performed a kidney tumor resection. 2
• Only 39.9% performed biliary atresia or choledochal cyst surgery. 2

Referral Considerations

All patients 5 years or younger requiring surgical care should be managed by a pediatric surgeon. 1

• Children with medical conditions increasing operative risk (congenital heart disease, prematurity) undergoing common procedures like hernia repair should be cared for by pediatric surgeons. 1
• Minimally invasive procedures (laparoscopy, thoracoscopy) in infants and children should be performed by pediatric surgeons trained in these techniques. 1