Sharp Declines in Rates of Surgery Among Infants

By Anne Harding

October 09, 2019

NEW YORK (Reuters Health) - Children under 3 are less likely to undergo surgery today than they were two decades ago, with the largest drop seen in infants, according to new research.

"Our findings support the hypothesis that alternative factors including parental and practitioner concerns about anesthetic exposure may have affected surgical decision-making in infants," Dr. Ethan L. Sanford of UT Southwestern Medical Center in Dallas and colleagues conclude in JAMA Pediatrics, online October 7.

In 2016, the U.S. Food and Drug Administration issued a warning against "repeated or lengthy" exposure to anesthetics in children younger than 3, based on concerns about effects on brain development, Dr. Sanford and colleagues note.

While research since then found no effects in infants exposed to anesthesia for short periods of time, they add, parents and clinicians may still be deciding against exposing young children to anesthesia due to fears about neurological effects.

Using data from the National Health Interview Survey, the authors investigated trends in surgery in young children from 1998 to 2017. Among nearly 42,000 children under 3 included in the analysis, 6.9% underwent surgery in the previous year.

The odds of undergoing surgery declined significantly over the study period, with the sharpest drop seen in 2008-2012 (adjusted odds ratio, 0.87) and 2013-2017 (AOR, 0.78).

The decline was most significant among children under 1, with an adjusted decrease of 0.69 in 2008-2012 and 0.61 in 2013-2017.

Period prevalence of surgery also declined steadily over time among infants, at 108 per 1,000 children in 1998-2002; 94 per 1,000 children in 2003-2007; 81 per 1,000 in 2008-2012; and 75 per 1,000 in 2013-2017.

Black children had significantly reduced odds of surgery compared to whites (AOR, 0.68), as did Asian-American children (AOR, 0.46) and Hispanic children (AOR 0.56). Uninsured children and children with no health visit were also less likely to have surgery (AORs 0.61 and 0.65, respectively).

Factors linked to an increased likelihood of surgery included maternal education beyond high school; living in the North Central or Midwestern U.S.; living in the South; low birthweight; trisomy 21; and congenital heart disease.

Dr. Sanford said he found the large drop in surgeries surprising. "We can’t confidently say exactly why we saw that decline," he told Reuters Health by phone.

No major changes in clinical practice over the study period explain the decline, the researcher noted, while the fact that the drop was biggest among the youngest children suggests neurological concerns about surgery and anesthesia could be a factor.

He and his colleagues now plan to investigate whether the trend has resulted in some children going without needed operations due to unsubstantiated concerns about anesthesia, as well as the greater decline seen among non-white children.

"There are certainly indications that non-clinical factors play a role in the receipt of therapy, and is that good or bad? It’s difficult to know, but these are things that warrant further investigation," he said.


JAMA Pediatr 2019.