Melanie Duval1, Jacob Wilkes2, Kent Korgenski2, Rajendu Srivastava3, Jeremy Meier4. 1. Department of Otolaryngology, McGill University, Montreal, Canada. Electronic address: melanie.duval@mcgill.ca. 2. Intermountain Healthcare, Pediatric Clinical Program, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. 3. Intermountain Healthcare, Murray, UT, USA; Division of Pediatric Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. 4. Division of Otolaryngology, University of Utah, UT, USA.
Abstract
OBJECTIVE: To review the causes, costs, and risk factors for unplanned return visits and readmissions after pediatric adenotonsillectomy (T&A). METHODS: Review 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. RESULTS: Data 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 child's age and the risk of post-tonsillectomy hemorrhage. CONCLUSION: Children 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.
OBJECTIVE: To review the causes, costs, and risk factors for unplanned return visits and readmissions after pediatric adenotonsillectomy (T&A). METHODS: Review 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. RESULTS: Data 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 child's age and the risk of post-tonsillectomy hemorrhage. CONCLUSION:Children 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.
Authors: David O Francis; Christopher Fonnesbeck; Nila Sathe; Melissa McPheeters; Shanthi Krishnaswami; Sivakumar Chinnadurai Journal: Otolaryngol Head Neck Surg Date: 2017-01-17 Impact factor: 3.497
Authors: Claire M Lawlor; Charles A Riley; John M Carter; Kimsey H Rodriguez Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-05-01 Impact factor: 6.223
Authors: Allison G Ordemann; Anna Jade Hartzog; Samantha R Seals; Christopher Spankovich; Scott P Stringer Journal: Laryngoscope Investig Otolaryngol Date: 2018-05-14
Authors: Kathleen R Billings; Renee C B Manworren; Jennifer Lavin; Christine Stake; Ferdynand Hebal; Astrid H Leon; Katherine Barsness Journal: Laryngoscope Investig Otolaryngol Date: 2018-12-28
Authors: Young Kang; Eu Jeong Ku; Il Gu Jung; Min Hyuck Kang; Young-Seok Choi; Hahn Jin Jung Journal: Medicine (Baltimore) Date: 2021-01-15 Impact factor: 1.817
Authors: Aimy H L Tran; Ken L Chin; Rosemary S C Horne; Danny Liew; Joanne Rimmer; Gillian M Nixon Journal: J Otolaryngol Head Neck Surg Date: 2022-01-12