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. 2023 Aug;169(2):258-266.
doi: 10.1002/ohn.268. Epub 2023 Feb 5.

Estimations of Inpatient and Ambulatory Pediatric Tonsillectomy in the United States: A Cross-sectional Analysis

Romaine F Johnson  1   2 , Jinghan Zhang  1 , Stephen R Chorney  1   2 , Yann-Fuu Kou  1   2 , Felicity Lenes-Voit  1   2 , Seckin Ulualp  1   2 , Christopher Liu  1   2 , Ron B Mitchell  1   2
Affiliations

Estimations of Inpatient and Ambulatory Pediatric Tonsillectomy in the United States: A Cross-sectional Analysis

Romaine F Johnson et al. Otolaryngol Head Neck Surg. 2023 Aug.

Abstract

Objective: To estimate the incidence of inpatient and ambulatory pediatric tonsillectomies in the United States in 2019.

Study design: Cross-sectional analysis.

Setting: Healthcare Cost and Utilization Project databases.

Methods: We determined national incidences of hospital-based ambulatory procedures, inpatient admissions, and readmissions among pediatric tonsillectomy patients, ages 0 to 20 years, using the Kids Inpatient Database, Nationwide Ambulatory Surgery Sample, and Nationwide Readmission Database. We described the demographics, commonly associated conditions, complications, and predictors of readmission.

Results: An estimated 559,900 ambulatory and 7100 inpatient tonsillectomies were performed in 2019. Among inpatients, the majority were male (59%) and the largest ethnic group was white (37%). Adenotonsillar hypertrophy (ATH), 79%, and obstructive sleep apnea (OSA), 74%, were the most frequent diagnosis and Medicaid (61%) was the most frequent primary payer. The majority of ambulatory tonsillectomy patients were female (52%) and white (65%); ATH, OSA, and Medicaid accounted for 62%, 29%, and 45% of cases, respectively, (all p < .001 when compared to inpatient cases). Common inpatient complications were bleeding (2%), pain/nausea/vomiting (5.6%), and postprocedural respiratory failure (1.7%). On the other hand, ambulatory complications occurred in less than 1% of patients. The readmission rate was 5.2%, with pain/nausea/vomiting and bleeding accounting for 35% and 23% of overall readmissions. All Patient Refined Diagnosis Related Groups severity of illness subclass predicted readmission (odds ratio = 2.18, 95% confidence interval = 1.73-2.73, p < .001).

Conclusion: A total of 567,000 pediatric ambulatory and inpatient tonsillectomies were performed in 2019; the majority were performed in ambulatory settings. The index admission severity of illness was associated with readmission risk.

Keywords: Healthcare Cost and Utilization Project; cross-sectional analysis; incidence; pediatric tonsillectomy.

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