TY - JOUR
T1 - Inpatient pediatric tonsillectomy
T2 - Does hospital type affect cost and outcomes of care?
AU - Raol, Nikhila
AU - Zogg, Cheryl K.
AU - Boss, Emily F.
AU - Weissman, Joel S.
N1 - Publisher Copyright:
© 2015 Official journal of the American Academy of Otolaryngology-Head and Neck Surgery Foundation.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Objective To ascertain whether hospital type is associated with differences in total cost and outcomes for inpatient tonsillectomy. Study Design Cross-sectional analysis of the 2006, 2009, and 2012 Kids' Inpatient Database (KID). Subjects and Methods Children ≤18 years of age undergoing tonsillectomy with/without adenoidectomy were included. Risk-adjusted generalized linear models assessed for differences in hospital cost and length of stay (LOS) among children managed by (1) non-children's teaching hospitals (NCTHs), (2) children's teaching hospitals (CTHs), and (3) nonteaching hospitals (NTHs). Risk-adjusted logistic regression compared the odds of major perioperative complications (hemorrhage, respiratory failure, death). Models accounted for clustering of patients within hospitals, were weighted to provide national estimates, and controlled for comorbidities. Results The 25,685 tonsillectomies recorded in the KID yielded a national estimate of 40,591 inpatient tonsillectomies performed in 2006, 2009, and 2012. The CTHs had significantly higher risk-adjusted total cost and LOS per tonsillectomy compared with NCTHs and NTHs ($9423.34/2.8 days, $6250.78/2.11 days, and $5905.10/2.08 days, respectively; P <.001). The CTHs had higher odds of complications compared with NCTHs (odds ratio [OR], 1.48; 95% CI, 1.15-1.91; P =.002) but not when compared with NTHs (OR, 1.19; 95% CI, 0.89-1.59; P =.23). The CTHs were significantly more likely to care for patients with comorbidities (P <.001). Conclusion Significant differences in costs, outcomes, and patient factors exist for inpatient tonsillectomy based on hospital type. Although reasons for these differences are not discernable using isolated claims data, findings provide a foundation to further evaluate patient, institutional, and system-level factors that may reduce cost of care and improve value for inpatient tonsillectomy.
AB - Objective To ascertain whether hospital type is associated with differences in total cost and outcomes for inpatient tonsillectomy. Study Design Cross-sectional analysis of the 2006, 2009, and 2012 Kids' Inpatient Database (KID). Subjects and Methods Children ≤18 years of age undergoing tonsillectomy with/without adenoidectomy were included. Risk-adjusted generalized linear models assessed for differences in hospital cost and length of stay (LOS) among children managed by (1) non-children's teaching hospitals (NCTHs), (2) children's teaching hospitals (CTHs), and (3) nonteaching hospitals (NTHs). Risk-adjusted logistic regression compared the odds of major perioperative complications (hemorrhage, respiratory failure, death). Models accounted for clustering of patients within hospitals, were weighted to provide national estimates, and controlled for comorbidities. Results The 25,685 tonsillectomies recorded in the KID yielded a national estimate of 40,591 inpatient tonsillectomies performed in 2006, 2009, and 2012. The CTHs had significantly higher risk-adjusted total cost and LOS per tonsillectomy compared with NCTHs and NTHs ($9423.34/2.8 days, $6250.78/2.11 days, and $5905.10/2.08 days, respectively; P <.001). The CTHs had higher odds of complications compared with NCTHs (odds ratio [OR], 1.48; 95% CI, 1.15-1.91; P =.002) but not when compared with NTHs (OR, 1.19; 95% CI, 0.89-1.59; P =.23). The CTHs were significantly more likely to care for patients with comorbidities (P <.001). Conclusion Significant differences in costs, outcomes, and patient factors exist for inpatient tonsillectomy based on hospital type. Although reasons for these differences are not discernable using isolated claims data, findings provide a foundation to further evaluate patient, institutional, and system-level factors that may reduce cost of care and improve value for inpatient tonsillectomy.
KW - academic medical centers
KW - children's hospitals
KW - cost of care
KW - cost variation
KW - teaching hospitals
KW - tonsillectomy
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U2 - 10.1177/0194599815621739
DO - 10.1177/0194599815621739
M3 - Article
C2 - 26701174
AN - SCOPUS:84959256821
SN - 0194-5998
VL - 154
SP - 486
EP - 493
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 3
ER -