State legislation and surgical demand: Operative needs of Texas infants after early abortion ban

The 2021 Texas Senate Bill 8 (SB8) restricts abortion after approximately six weeks' gestation. Prior statewide analyses have demonstrated increased congenital anomalies following SB8, but the operative implications of these changes remain unknown.

To evaluate changes in operative admissions, outcomes, and charges for infants with congenital anomalies in Texas before and after SB8 implementation.

We conducted a retrospective cohort study using the Texas Inpatient Public Use Data File. Inpatient admissions for infants younger than one year were analyzed a year before (July 1, 2020-June 30, 2021) and after (July 1, 2022-June 30, 2023) SB8. Operative admissions were identified using operating room charges. Primary outcomes included admission volume, mortality, length of stay, and hospital charges. Secondary outcomes included operative admissions by congenital anomaly organ system.

Operative admissions increased by 1121 in the post-SB8 year, though the overall proportion decreased (22.5 % pre-SB8 vs 20.5 % post-SB8). Operative admissions with congenital anomalies increased by 1443 (21.7 %-23.2 %). Median charge per operative admission with congenital anomalies increased by $7,001, contributing to a nearly $1.1 billion rise in aggregate charges (P < 0.0001). Mortality and median length of stay remained stable. Organ system analyses demonstrated varied changes, with the largest increases in circulatory, urinary, and genital anomalies.

The early abortion ban in Texas is associated with increased operative demand and higher inpatient charges for infants with congenital anomalies. These findings highlight the growing surgical and economic impact of abortion restrictions on pediatric healthcare systems.