O3252: 2015-2021 Industry Payments to Pediatric Orthopedic Surgeons: Analysis of Trends and Characteristics of Top-earning Surgeons

Background: Increased awareness of the benefits and biases of physician-industry relationships led to the establishment of the Open Payments Database (OPD) in 2014. Although one prior study investigated OPD payments to pediatric orthopaedic surgeons, analysis of data from 2018 to 2021 and characteristics of those receiving the highest aggregate payments were not conducted. In this study, we investigated payments to pediatric orthopedic surgeons from 2015 to 2021 to understand characteristics of surgeons associated with increased industry relationships.

Methods: OPD datasets from 2015 to 2021 were queried for payments to pediatric orthopedic surgeons. Interest/ownership datasets and research payments datasets were excluded. Annual general payment aggregates and subcategories were found and analyzed for trends. Using the Scopus database, Hirsch index (h-index-a measure of author manuscript citations) was found for each surgeon receiving payments in 2021. Gender and U.S. census division were collected using online physician hospital profiles. Chi square, Fisher exact, Mann-Whitney-U, and T-tests were utilized to evaluate for differences in gender, h-index, and U.S. census division characteristics between surgeons in the top 75th, 90th, and 95th percentiles of aggregate industry payments compared to the bottom 75%, 90%, and 95%.

Results: Aggregate industry payments rose 125% from 2015 to 2021. Payments in education (up 586%), royalties (up 333%), and faculty/speaker compensation (up 290%) increased the most since 2015. Payments in travel and lodging, honoraria, charitable contributions, and ownership interest were lower in 2021 than 2015. Payments in all categories except royalties fell from 2018 to 2020.

For 2021 aggregate industry payments, there were no differences between the proportions of male and female surgeons in the top 75th percentile (p = 0.054), 90th percentile (p = 0.235), and 95th percentile (p = 0.280), respectively. Furthermore, mean h-indexes of surgeons in the 75th percentile (p < 0.001, 95% CI 2.62-7.65), 90th percentile (p = 0.001, 95% CI 3.28-13.03), and 95th percentile (p = 0.005, 95% CI 4.25-21.11) were higher. Surgeons in the Middle Atlantic U.S. census division were less likely to be in the 90th percentile compared to those of combined remaining U.S. census divisions (p = 0.025). Those in the West South Central were less likely to be in the 95th percentile (p = 0.033), while surgeons in the Pacific were more likely to be in the 90th (p = 0.004) and 95th (p = 0.024) percentiles.

Conclusion: Although industry payments to pediatric orthopaedic surgeons rose from 2015 to 2021, there was a fall in payments across most categories from 2018 to 2020, related to the SARS-CoV-19 pandemic. In 2021, although gender was not correlated with aggregate payment volume, location in select U.S. census divisions and h-index were.