Jacob Wilkes

Surgeon Dependent Variation in Adenotonsillectomy Costs in Children

Objectives To (1) identify the major expenses for same-day adenotonsillectomy (T&A) and the costs for postoperative complication encounters in a children’s hospital and (2) compare differences for variations in costs by surgeon. Study Design Observational cohort study. Setting Tertiary children’s hospital. Subjects and Methods A standardized activity-based hospital accounting system was used to determine total hospital costs per encounter (not including professional fees for surgeons or anesthetists) for T&A cases at a tertiary children’s hospital from 2007 to 2012. Hospital costs were subdivided into categories, including operating room (OR), OR supplies, postanesthesia care unit (PACU), same-day services (SDS), anesthesia, pharmacy, and other. Costs for postoperative complication encounters were included to identify a mean total cost per case per surgeon. Results The study cohort included 4824 T&As performed by 14 different surgeons. The mean cost per T&A was

Causes, costs, and risk factors for unplanned return visits after adenotonsillectomy in children.

1506 (95% confidence interval,

Risk factors associated with preterm birth after a prior term delivery

1492-

Intrapartum Cervical Laceration and Subsequent Pregnancy Outcomes.

1519, with a range of

A Comparison of Ambulatory Care Sensitive Hospitalizations Among Children With and Without Autism Spectrum Disorder

1156-

Cervical spine imaging in hospitalized children with traumatic brain injury

1828 for the lowest and highest cost per case per surgeon; P < .01). Including the cost for postoperative complications, the mean cost increased to

Factors Associated With Resource Utilization and Coronary Artery Dilation in Refractory Kawasaki Disease (from the Pediatric Health Information System Database)

1599 (

Resource Utilization for Initial Hospitalization in Pediatric Heart Transplantation in the United States

1570-

Association of Maternal Preeclampsia With Infant Risk of Premature Birth and Retinopathy of Prematurity

1629). The largest cost categories included OR (31.9%), SDS (28.1%), and OR supplies (15.6%). Conclusion A large portion of T&A expenses are due to OR and supply costs. Significant differences in costs between surgeons for outpatient T&A were identified. Studies to understand the reasons for this variation and the impact on outcomes are needed. If this variation does not affect patient outcomes, then reducing this variation may improve health care value by limiting waste.

MULTICENTER EVALUATION OF CHARGES, LENGTH OF STAY AND MORTALITY DURING HOSPITALIZATION AFTER PEDIATRIC OPEN-HEART SURGERY ATTRIBUTABLE TO ADVERSE PATIENT-CARE EVENTS

OBJECTIVEnTo review the causes, costs, and risk factors for unplanned return visits and readmissions after pediatric adenotonsillectomy (T&A).nnnMETHODSnReview of administrative database of outpatient adenotonsillectomy performed at any facility within a vertically integrated health care system in the Intermountain West on children age 1-18 years old between 1998 and 2012. Data reviewed included demographic variables, diagnosis associated with return visit and costs associated with return visits.nnnRESULTSnData from 39,906 children aged 1-18 years old were reviewed. A total of 2499 (6.3%) children had unplanned return visits. The most common reasons for return visits were bleeding (2.3%), dehydration, (2.3%) and throat pain (1.2%). After multivariate analysis, the main risk factors for any type of return visits were Medicaid insurance (OR=1.64 95% CI 1.47-1.84), Hispanic race (OR=1.36 95% CI 1.13-1.64), and increased severity of illness (SOI) (OR=11.29 95% CI 2.69-47.4 for SOI=3). The only factor associated with increased odds of requiring an inpatient admission on return visit was length of time spent in PACU (p<0.001). A linear relationship was also observed between the childs age and the risk of post-tonsillectomy hemorrhage.nnnCONCLUSIONnChildren with increased severity of illness, those insured with Medicaid, and children of Hispanic ethnicity should be targeted with increased education and interventions in order to reduce unplanned visits after T&A. Further studies on post-tonsillectomy complications should include evaluating the effect of surgical technique and post-operative pain management on all complications and not solely post-tonsillectomy hemorrhage.