Causes and Costs for ED Visits after Pediatric Adenotonsillectomy. (April 2015)

• Record Type: Journal Article
• Authors: Curtis, Jonathan L.; Harvey, D. Brandon; Willie, Scott; Narasimhan, Evan; Andrews, Seth; Henrichsen, Jake; Van Buren, Nicholas C.; Srivastava, Rajendu; Meier, Jeremy D.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 152:Number 4(2015:Apr.)
• Page Start: 691
• Page End: 696
• Publication Date: 2015-04
• Subjects: emergency department -- pediatric adenotonsillectomy; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599815572123
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: (1) Review the reasons, timing, and costs for children presenting to the emergency department (ED) after adenotonsillectomy (T&A). Study Design: Case series with chart review. Setting: Tertiary care children's hospital. Subjects and Methods: A standardized activity-based hospital accounting system was used to identify 437 children from an academic pediatric otolaryngology practice presenting to the ED after T&A from 2009 to 2012. The reason for presentation, timing after surgery, and facility costs were recorded. Results: The study cohort represented 13.3% of the 3198 patients who underwent T&A during that time period. Overall, 133 (4.2%) presented for dehydration, 106 (3.3%) presented for post-tonsillectomy hemorrhage, 65 (2.0%) for poorly controlled pain, 42 (1.3%) for fever, 29 (1.0%) for vomiting/nausea/GI discomfort, 22 (0.7%) for respiratory complications, and 12 (0.4%) for miscellaneous reasons related to the operation; 28 (0.8%) were unrelated to the T&A and excluded. Mean postoperative day at the time of ED presentation was 4.4 (95% CI, 4.1-4.7). The mean cost per patient presenting to the ED was $1420 (95% CI, $1104-$1737), the most costly subgroups being those presenting with respiratory complications ($2855; 95% CI, $1434-$4277), hemorrhage ($1502; 95% CI, $1216-$1787), and dehydration ($1372; 95% CI, $995-$1750). The least costly subgroup was acute postoperative pain ($781; 95% CI, $282-$1200). Conclusion: A significant portion of children present to the ED after T&A for poorly controlled pain, dehydration, or fever. The costs from these visits are significant. Accounting for these costs in the global care for pediatric T&A could assist in calculating appropriate reimbursement for bundled payments in this climate of health care reform.