How Childhood Obesity Impacts Outpatient Surgery
Featured paper: Childhood obesity trends: Association with same-day hospital admission in a National Outpatient Surgical Population
Disclaimer: This content was generated by NotebookLM and has been reviewed for accuracy by Dr. Tram.
Today, we’re diving into a really important topic that sits at the intersection of public health, pediatrics, and surgical care: childhood obesity and its surprising connection to whether kids go home after surgery or stay in the hospital. We’ll be breaking down a recent research paper by Tram et al. (2023) that shed some crucial light on this evolving challenge.
Why Is This Important? The Double Whammy of Rising Trends
You probably already know that childhood obesity is a major concern globally. It’s not just about weight; it puts kids at risk for various short-term and chronic health issues. What you might not realize is how this epidemic is intersecting with another big trend in healthcare: the rise of outpatient surgery.
More and more surgical procedures are moving from inpatient hospital stays to outpatient settings. This means patients come in for surgery and are expected to go home the same day. This shift is driven by advancements in medical care and a push to keep healthcare costs down.
So, here’s the “double whammy”: we have more children who are overweight or obese, and more of them are undergoing surgeries in settings where they’re expected to be discharged quickly. This raises a critical question: Are these children truly suitable for same-day discharge, or are they more likely to need an unexpected hospital stay? Until recently, this specific question hadn’t really been explored in detail for children undergoing outpatient surgery.
The Study: Peeking into National Data
That’s where the research by Tram et al. comes in. This study was designed to answer two key questions:
- How have obesity trends changed among children having scheduled outpatient, non-bariatric surgery between 2012 and 2019?
- Is there a link between a child’s obesity status and their risk of being admitted to the hospital on the same day after outpatient surgery?
To find these answers, the researchers looked at a huge amount of data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. This database collects information from over 148 hospitals, covering a wide range of perioperative details and patient outcomes.
They focused on 152,918 children aged 2 to 18 years who had outpatient surgery under general anesthesia. To make sure their findings were clear, they excluded patients with certain complex conditions or emergency surgeries.
The children were classified into different BMI (Body Mass Index) categories:
- Overweight: BMI at or above the 85th percentile.
- Class 1 Obesity: BMI at or above the 95th percentile or ≥30 kg/m2.
- Class 2 Obesity (Severe Obesity): BMI at or above 120% of the 95th percentile or ≥35 kg/m2.
- Class 3 Obesity (Severe Obesity): BMI at or above 140% of the 95th percentile or ≥40 kg/m2.
- Healthy Weight was the reference group for comparison.
The main outcome they were interested in was “same-day hospital admission,” which meant a hospital stay of at least one day after scheduled ambulatory surgery. This is significant because unexpected admissions can be costly and stressful for families.
What Did They Find? Alarming Trends and Clear Links
The results from this study are quite eye-opening:
1. Obesity Rates Are Rising, Especially Severe Obesity:
- From 2012 to 2019, the prevalence of all high BMI categories increased.
- The most concerning increase was in extreme obesity (Class 3 obesity), which rose from 2.54% in 2012 to 3.37% in 2019. This represents a 32.5% increase for Class 3 obesity and 26.7% for Class 2 obesity during that period.
- Teenagers (12-18 years old) with severe obesity (Class 3) showed the highest proportional increase among all age groups, jumping by 61.6% from 2012 to 2019.
2. Obesity Status Increases the Risk of Hospital Admission:
- The study found a “monotonic association” between obesity status and the risk of same-day hospital admission. This means that as a child’s BMI category increased, so did their chances of being admitted to the hospital.
- Compared to healthy weight children, overweight and obese children had relatively higher odds of same-day hospital admission.
- Children with Class 2 obesity had 9% higher odds of same-day hospital admission.
- Children with Class 3 obesity had significantly higher odds—20% higher—of same-day hospital admission compared to healthy weight children. The actual admission rates were 28.4% for Class 3 obesity, compared to 22.9% for overweight patients and 22.7% for Class 1 obesity.
What Does This Mean for Healthcare?
These findings have major implications for how we plan and deliver pediatric surgical care:
- Rethinking Outpatient Suitability: The study suggests that while a previous review article suggested all obese children (BMI ≥95th percentile) might not be suitable for ambulatory surgery, this new data indicates that children with Class 3 obesity are a particularly high-risk group for unexpected admission.
- A “Threshold” for Admission Risk: The researchers propose that Class 3 obesity (BMI ≥140% of the 95th percentile or ≥40 kg/m2) appears to be a reasonable threshold above which children should probably not be scheduled for ambulatory surgery. This is a crucial insight for clinicians deciding where to perform surgery.
- Challenges for Caregivers: As the number of severely obese children needing surgery increases, perioperative caregivers will need to adapt to providing safe and complex care in outpatient settings, or ensure appropriate inpatient facilities are available.
- Cost and Resource Allocation: Unexpected hospital admissions are not only inconvenient for families but also expensive and impact hospital resource allocation. Identifying high-risk patients beforehand can help manage these resources better.
This study aligns with some findings in adult patients, where severe obesity was also linked to increased hospital admissions after certain outpatient procedures. However, it’s the first pediatric study of its kind to look at these specific trends and associations.
Important Considerations (Limitations)
No study is perfect, and this research also has some limitations worth noting:
- Data Accuracy: The accuracy of height and weight measurements used to calculate BMI couldn’t be independently verified, and measurement techniques might have varied across different hospitals.
- Surgical Extent: The study didn’t assess the extent or complexity of the surgeries performed across different specialties. It’s possible that obese patients might have had less extensive surgeries, which could affect the admission risk.
- “Outpatient in a Bed” Scenarios: The database didn’t capture cases where patients were scheduled as “outpatient in a bed” – meaning they were tentatively planned for admission but discharged if no complications arose.
- Reason for Admission: The data didn’t provide specific details on why a child was admitted, only that they stayed ≥1 day. While often due to unexpected complications, the exact clinical reasons aren’t known.
- Database Scope: The NSQIP-P database primarily includes hospital data and doesn’t cover freestanding ambulatory surgery centers (ASCs). This means the findings might be more applicable to hospitals with admission facilities, and a different (potentially lower) obesity threshold might be needed for ASCs.
The Future of Pediatric Surgical Care
Despite these limitations, this study is a step forward in understanding the impact of the obesity epidemic on pediatric surgical care. It provides the largest report to date on obesity trends and outcomes in children undergoing elective ambulatory operations.
The takeaway is clear: targeted efforts are urgently needed to help select the right patients for pediatric outpatient surgery. For children with Class 3 obesity, a higher likelihood of hospital admission means we need to carefully consider whether an outpatient setting is truly the safest and most appropriate choice.
This research paves the way for future studies to dig deeper into why children with severe obesity have higher admission rates and how we can better support them during and after surgery. It’s a call to action for healthcare providers, policymakers, and communities to address childhood obesity and ensure the safest outcomes for our youngest patients.