Melanie Duval

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

Influence of leukotriene gene polymorphisms on chronic rhinosinusitis

1506 (95% confidence interval,

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

1492-

A diagnostic paradigm including cytomegalovirus testing for idiopathic pediatric sensorineural hearing loss

1519, with a range of

Facial Nerve Palsy in Neonates Secondary to Forceps Use

1156-

Ototoxicity of topical moxifloxacin in a chinchilla animal model.

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

The effect of age on pediatric tympanoplasty outcomes: A comparison of preschool and older children

1599 (

A Case-Control Study of Repeated Adenoidectomy in Children

1570-

Retropharyngeal and parapharyngeal abscesses or phlegmons in children. Is there an association with adenotonsillectomy

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.

Role of operative airway evaluation in children with recurrent croup: a retrospective cohort study

BackgroundChronic rhinosinusitis (CRS) is increasingly viewed as an inflammatory condition of the sinonasal mucosa interacting with bacteria and/or fungi. However, factors conferring susceptibility to disease remain unknown. Advances in genomics offer powerful tools to explore this disorder. The goal of this study was to evaluate the effect of single nucleotide polymorphisms (SNP) on CRS in a panel of genes related to cysteinyl leukotriene metabolism.MethodsSevere cases of CRS and postal code match controls were recruited prospectively. A total of 206 cases and 200 controls were available for the present study. Using a candidate gene approach, five genes related to cysteinyl leukotriene metabolism were assessed. For each gene, we selected the maximally informative set of common SNPs (tagSNPs) using the European-derived (CEU) HapMap dataset. These SNPs are in arachidonate 5-lipoxygenase (ALOX5), arachidonate 5-lipoxygenase-activating protein (ALOX5AP), leukotriene C4 synthase (LTC4S), cysteinyl leukotriene receptor 1 (CYSLTR1) and cysteinyl leukotriene receptor 2 (CYSLTR2) genes.ResultsA total of 59 SNPs were genotyped to capture the common genetic variations within these genes. Three SNPs located within the ALOX5, CYSLTR1 and ALOX5AP genes reached the nominal p-value threshold (p < 0.05) for association with CRS. However, none of these SNPs resist multiple testing adjustment.ConclusionWhile these initial results do not support that polymorphsims in genes assessed involved in the leukotriene pathways are contributing to the pathogenesis of CRS, this initial study was not powered to detect polymorphisms with relative risk of 2.0 or less, where we could expect many gene effects for complex diseases to occur. Thus, despite this lack of significant association noted in this study, we believe that validation with external populations and the use of better-powered studies in the future may allow more conclusive findings.