Childhood obesity trends: Association with same‐day hospital admission in a National Outpatient Surgical Population

Abstract

Background Although the prevalence of obesity in the general population and its perioperative implications among children undergoing inpatient surgeries are well known, little is known about obesity prevalence among children scheduled for ambulatory surgery. Aims Here, we report the trends of obesity and severe obesity among children who underwent ambulatory surgery across multiple centers in the United States and explore the association of obesity status with admission following elective ambulatory surgery. Materials and Methods Using data from the American College of Surgeons National Surgical Quality Improvement Program‐Pediatric (2012–2019), we selected children 2–18 years old who underwent outpatient surgical procedures under general anesthesia and had documented height, weight, and body mass index (BMI) data. We estimated the prevalence of overweight, obesity (class 1), and severe obesity (class 2 and class 3) patients and explored their association with same‐day hospital admission, defined as hospital length of stay ≥1 day. Results Data from 152 918 children (mean age: 9.7 ± 4.7 years) were analyzed. Of these, 16.4% (n = 25 007) were overweight, 13.8% (n = 21 085) were class 1 obese, 5.2% (n = 7879) were class 2 obese, and 3.0% (n = 4623) were class 3 obese. From 2012 to 2019, class 2 or 3 obesity prevalence increased by 26.7% and 32.5%, respectively. Overweight and obese children had relatively higher odds of same‐day hospital admission compared to healthy weight children (overweight odds ratio [95% confidence interval]: 1.05 [1.02, 1.08]; class 1 obesity: 1.04 [1.00, 1.07]; class 2 obesity: 1.09 [1.02, 1.16]; class 3 obesity: 1.20 [1.11, 1.30]). Discusion and Conclusion The burden of obesity continues to increase in children scheduled for ambulatory surgery. Children with class 2 and class 3 obesity have higher rates of same‐day hospital admission following elective ambulatory surgery compared to healthy weight children, a factor that should be considered in scheduling these patients.

The high-risk pediatric patient for ambulatory surgery

“…Obesity increases perioperative respiratory adverse events [7 ▪ ,19] as well as the likelihood of unanticipated admission [7 ▪ ,22 ▪▪ ]. A recent study of the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database by Tram et al [22 ▪▪ ] found higher rates of same day hospital admission following elective ambulatory surgery in children with severe (Class 2/3) obesity compared to healthy weight children. This finding is even more striking in light of the fact that NSQIP-P does not collect data on routine tonsillectomies, or any data from freestanding ASCs.…”

The emerging landscape of ambulatory surgery and anesthesia

“…624-629) provide a detailed description of expanded measures of quality and outcomes in ambulatory surgery with a discussion of patient reported outcome measures and value-based care. Pediatric patients undergoing ambulatory surgery were long considered ''healthy'' but that is no longer true given the increasing prevalence of obesity and associated comorbidities in this population [7]. Weber et al (pp.…”