Background: In vivo animal studies indicate that the developing brain is vulnerable to the neurotoxic effects of anesthetic agents. There is corresponding concern about the long-term neurological effects of early-in-life exposure in children at both the individual and population levels. Accurate national estimates of the number of children undergoing surgical procedures are required to understand the scope of this potential problem.
Methods: We estimated annual frequencies of in-hospital surgical procedures performed on children in the United States using the 2003, 2006, and 2009 Kids' Inpatient Database (KID). The KID is produced as part of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality and contains a representative national sample of pediatric discharges. Demographic variables and procedure categories were assessed in this cohort to determine rates and types of surgery.
Results: Over the 3 years evaluated, surgical diagnoses accounted for 12.7% of all discharges, with an average of 450,000 pediatric inpatient surgical admissions each year and 115,000 admissions annually in children under the age of 3. Elective admissions made up 40% of surgical hospitalizations with 55% of surgical admissions classified as gastrointestinal, orthopedic, or urological.
Conclusions: In the United States, approximately 450,000 children under 18 years of age are admitted for surgery as inpatients annually. One quarter of these children are under 3 years of age and the majority for gastrointestinal, orthopedic, or urological surgery. When examined together with data on ambulatory surgery, these results are useful in considering the scope of anesthesia exposure in young children.