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Epidemiologic Analysis of Elective Operative Procedures in Infants Less Than 6 Months of Age in the United States

Einhorn, Lisa M. MD*; Young, Brian J. MD; Routh, Jonathan C. MD, MPH; Allori, Alexander C. MD, MPH; Tracy, Elisabeth T. MD§; Greene, Nathaniel H. MD, MHS

doi: 10.1213/ANE.0000000000002185
Healthcare Economics, Policy and Organization: Original Clinical Research Report

BACKGROUND: This study uses publicly available data to analyze the total number of elective, potentially deferrable operative procedures involving infants <6 months of age in the United States. We investigated the factors associated with the performance of these procedures in this population.

METHODS: The State Ambulatory Surgery Database was used to identify patients in California, North Carolina, New York, and Utah during the years of 2007–2010 who were younger than 6 months of age at the time that they underwent outpatient (ambulatory) surgery. Operations that could reasonably be postponed until 6 months of age were classified as potentially deferrable procedures. Hernia repairs were analyzed separately from other deferrable procedures. Primary outcomes included the total number of elective procedures and the number and rates of potentially deferrable procedures per state per year in this population.

RESULTS: Over the study period, a total of 27,540 procedures were identified as meeting inclusion criteria; of those, 7832 (28%) were classified as potentially deferrable, 4315 of which were hernia repairs. The average rates of potentially deferrable nonhernia procedures in California, North Carolina, New York, and Utah were 8.3, 43.8, 30.0, and 11.7 per 10,000 person-years, respectively. In multivariable analysis, private insurance (odds ratio [OR] = 1.36), self-pay status (OR = 1.50), and treatment in a different state (OR = 0.48–3.16) were independent predictors of a potentially deferrable procedure being performed on an infant younger than 6 months.

CONCLUSIONS: Potentially deferrable procedures are still performed in infants <6 months of age. There appears to be significant variation in timing of these procedures among states. Insurance status and geography may be independent predictors of a procedure being potentially deferrable.

Supplemental Digital Content is available in the text.Published ahead of print June 16, 2017.

From the *Division of Pediatric Anesthesia, Department of Anesthesiology; Division of Urology; Division of Plastic, Maxillofacial and Oral Surgery; §Division of Pediatric Surgery, Department of Surgery; and Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina.

Accepted for publication April 6, 2017.

Published ahead of print June 16, 2017.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Nathaniel H. Greene, MD, MHS, Department of Anesthesiology, Duke University School of Medicine, 2301 Erwin Rd, 5671 HAFS, Durham, NC 27710. Address e-mail to nathaniel.greene@dm.duke.edu.

© 2017 International Anesthesia Research Society
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