National medical expenditures associated with pediatric surgical care in the United States.

PURPOSE: Surgical care accounts for a large proportion of U.S. healthcare costs, yet comprehensive data on pediatric surgical expenditures remain limited. This study provides nationally representative estimates of medical expenditures associated with pediatric surgery in the United States. METHODS: We performed cross-sectional analysis of children ages 0-18 years participating in the 2017-2022 Medical Expenditure Panel Survey (n=39,926). Children were considered to have undergone surgery if they had at least one medical encounter with the primary reason being an "operation or surgical procedure." Multivariable regression models were used to estimate incremental medical expenditures associated with surgery, adjusting for sociodemographic characteristics and comorbidity burden. RESULTS: The overall weighted prevalence of surgery was 4.1% (95% CI: 3.9-4.4). After adjustment for sociodemographic and comorbid conditions, children who underwent surgery had significantly higher total per-person medical expenditures compared to those who did not ($13,271 vs $2,198, respectively; p<0.0001). This resulted in an incremental expenditure associated with surgery of $11,072 (95% CI: $7,677-$14,467). Weighted to the national population, pediatric surgical expenditures averaged 35.4 billion dollars per year (95% CI: $24.5 billion- $46.3 billion). When examined by service category, the highest incremental expenditures were for inpatient services ($4,854) and office-based visits ($2,030). When categorized by payment source, the largest incremental expenditures were borne by private insurance ($5,417) and Medicaid/CHIP ($4,867), with significant increases also noted for out-of-pocket expenditures ($522). CONCLUSION: Pediatric surgery is associated with substantial economic burden of over $11,000 per child and over $35 billion dollars nationally. These findings underscore the significant financial impact of surgical care and can inform healthcare policy and resource allocation decisions.