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

Anesth Analg. 2017 Nov;125(5):1588-1596. doi: 10.1213/ANE.0000000000002185.


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.

MeSH terms

  • Age Factors
  • Ambulatory Surgical Procedures / economics
  • Ambulatory Surgical Procedures / statistics & numerical data*
  • Databases, Factual
  • Elective Surgical Procedures / economics
  • Elective Surgical Procedures / statistics & numerical data*
  • Female
  • Health Care Costs
  • Health Expenditures
  • Healthcare Disparities / economics
  • Healthcare Disparities / statistics & numerical data*
  • Herniorrhaphy / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Insurance, Health / economics
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Odds Ratio
  • Patient Safety
  • Process Assessment, Health Care / statistics & numerical data*
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • United States